CPT code 19020: Breast abscess drainage, deep abscess, open approach2026 Medicare rate & RVUs in Texas
Report this service when a surgeon incises breast tissue to explore and drain a deep abscess rather than aspirating a fluid collection.
Medicare pays $479.88–$531.95 for 19020 in the office in Texas, from Beaumont, TX to Austin, TX. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
What 19020 covers
This service involves an incision into the breast to reach, explore, and drain a deep abscess. It is typically performed by a breast or general surgeon in an operating room or other procedural setting when the collection requires open drainage. The operative record should identify the breast and side, describe the incision and abscess cavity, and document exploration and drainage. Needle aspiration of a cyst or fluid collection is a different service.
Report the service for the breast treated; when both breasts are treated, CMS recognizes bilateral billing with modifier 50 and pays at 150%. The day-before preoperative visit and 90 days of related postoperative care are included in the major-surgery global period. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures at 50%. CMS does not pay an assistant at surgery, and co-surgeons and team surgery are not permitted.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 19020 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 payment localities
$479.88 to $531.95
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin, TX | $531.95 | $322.39 |
| Beaumont, TX | $479.88 | $299.64 |
| Brazoria, TX | $505.38 | $309.09 |
| Dallas, TX | $509.70 | $312.42 |
| Fort Worth, TX | $506.50 | $311.21 |
| Galveston, TX | $507.57 | $310.89 |
| Houston, TX | $524.41 | $327.73 |
| Rest of Texas | $493.08 | $305.12 |
How the 19020 rate is calculated
Each of 19020’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 19020
RVUs × geographic indexes × conversion factor
Work3.73
3.73 RVUs× 1.000 GPCI
Practice expense10.75
10.75 RVUs× 1.000 GPCI
Malpractice0.92
0.92 RVUs× 1.000 GPCI
Adjusted RVUs
15.4000
Conversion factor
$33.4009
Medicare rate
$514.37
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 19020
19020 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 19020
Breast abscess drainage, deep abscess, open approach
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.71/0.19 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 19020
Breast abscess drainage, deep abscess, open approach
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
19020 without 50 · national office
$514.37
Breast abscess drainage, deep abscess, open approach
19020-50 · Bilateral: 150%
$771.56
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
19020 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 19000Breast aspirationFirst cyst
- 19000 describes needle aspiration of a breast cyst or fluid collection. Choose 19020 when the surgeon incises breast tissue to explore and drain a deep abscess.
- 19001Breast cyst aspirationEach additional cyst
- 19001 is for each additional breast cyst aspirated and is reported with 19000; it does not describe open abscess drainage.
- 19101Breast biopsyOpen, incisional
- 19101 is an open breast biopsy to obtain tissue for diagnosis. Choose 19020 when the operative purpose is exploration and drainage of a deep abscess.
19020 billing questions
When is this code more appropriate than breast cyst aspiration?
Use this code when the surgeon makes an incision to explore and drain a deep breast abscess. Needle aspiration of a breast cyst or fluid collection is represented by 19000 instead.
Can exploration and drainage be reported as separate services?
No. Exploration and drainage are part of the open abscess service; document both in the operative report rather than unbundling them.
How should bilateral treatment be reported?
For procedures on both breasts, CMS recognizes modifier 50 and pays at 150%. Document the treatment performed on each side.
What postoperative care is included?
The major-surgery global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant surgeon or co-surgeon be billed?
CMS does not pay an assistant at surgery for this code. Co-surgeons and team surgery are not permitted.
What happens when another procedure is performed in the same session?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
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