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CPT code 19020: Breast abscess drainage, deep abscess, open approach2026 Medicare rate & RVUs in Utah

Report this service when a surgeon incises breast tissue to explore and drain a deep abscess rather than aspirating a fluid collection.

CMS RVU26DEffective Oct 1, 2026One payment locality921 Medicare services in 2024

In Utah, Medicare pays $489.70 for 19020 in the office and $303.51 when it’s performed in a hospital or facility.

$489.70Office (non-facility)
$303.51Hospital or facility
−4.8%vs the national office rate ($514.37)

Check a contract rate as a % of Medicare · 19020 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

We’ll open 19020 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Utah
  2. What 19020 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

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.

How Utah compares for 19020

Across 109 of 109 payment localities, the office rate for 19020 runs from $448.84 in Arkansas to $672.52 in San Benito County, CA. Utah pays $489.70. The RVUs are the same everywhere; the geographic indexes change the dollars.

19020 in Utah vs other payment areas
  1. Utah · this page$489.70
  2. Los Angeles, CA · California$574.86+$85.16
  3. Washington, DC area · District of Columbia$588.49+$98.79
  4. Miami, FL · Florida$576.08+$86.38
  5. Chicago, IL · Illinois$556.84+$67.14
  6. Manhattan, NY · New York$598.52+$108.82
  7. Alaska · Alaska$586.21+$96.51

Other areas in Utah first, then benchmark localities. Bars start at $0.

Every other payment area

19020 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$456.16$282.85
ArkansasArkansas$448.84$278.70
ArizonaArizona$498.82$306.89
Bakersfield, CACalifornia$539.20$322.11
Chico, CACalifornia$536.70$319.62
El Centro, CACalifornia$536.86$319.78
Fresno, CACalifornia$536.70$319.62
Hanford, CACalifornia$536.70$319.62

19020 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$448.84

$604.61

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
19020 office rate range by state
State / territoryOffice rate rangeLocalities
AK$586.211
AL$456.161
AR$448.841
AZ$498.821
CA$536.70–$672.5229
CO$532.121
CT$550.971
DC$588.491
DE$507.581
FL$514.03–$576.083
GA$481.50–$526.672
GU$550.631
HI$550.631
IA$465.321
ID$469.451
IL$500.44–$556.844
IN$472.371
KS$464.661
KY$471.911
LA$471.79–$497.372
MA$529.16–$585.762
MD$517.41–$588.493
ME$474.03–$499.802
MI$487.10–$522.892
MN$503.151
MO$464.02–$497.203
MS$456.441
MT$514.311
NC$479.221
ND$496.121
NE$467.611
NH$525.251
NJ$555.37–$581.762
NM$490.751
NV$509.601
NY$487.29–$616.545
OH$483.381
OK$469.101
OR$503.81–$548.362
PA$483.24–$537.272
PR$517.861
RI$525.271
SC$482.481
SD$493.971
TN$467.471
TX$479.88–$531.958
UT$489.701
VA$499.24–$588.492
VI$517.861
VT$495.601
WA$527.68–$596.492
WI$478.031
WV$480.581
WY$506.381

See 19020 in every payment locality

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

Office or facility?

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.

The exact Utah inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

1,657

Code
19020
Physician work
3.73
Practice expense
10.75
Malpractice
0.92

GPCI2026.csv

104

Locality
Utah
Physician work
1.000
Practice expense
0.940
Malpractice
0.898
Office calculation for 19020 in Utah
ComponentRVULocality factorAdjusted
Physician work3.73× 1.0003.7300
Practice expense10.75× 0.94010.1050
Malpractice0.92× 0.8980.8262
Total RVUs14.6612
Conversion factor× 33.4009

Office rate, Utah$489.70

Office: (3.73 × 1 + 10.75 × 0.94 + 0.92 × 0.898) × $33.4009 = $489.70

Facility: (3.73 × 1 + 4.82 × 0.94 + 0.92 × 0.898) × $33.4009 = $303.51

Open 19020 in the RVU calculator

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

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.71/0.19Share 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.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

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).

When to use modifier 50

Codes related to 19020

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 19020
CodeHow it relatesOffice range, Utah
Used instead
19000Breast aspiration, first cystNeedle aspiration of a breast cyst or fluid collection, rather than open drainage of a deep abscess.$91.91
19001Breast cyst aspiration, each additional cystAdditional breast cyst aspiration when multiple cysts are aspirated; reported with 19000.$25.56
10060Abscess drainage, simple, single abscessSimple or single abscess drainage in situations managed as a superficial skin abscess rather than a deep breast abscess.$123.08
10061Abscess drainage, complex or multipleComplicated or multiple superficial skin abscess drainage, distinct from open drainage of a deep breast abscess.$211.23

How 19020 has changed in Utah

19020 · Office / nonfacility

$489.70

Effective 2026-10-01

The base rate is $64.11 higher than on 2025-10-01, moving from $425.59 to $489.70 (15.1%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $425.59changed to$489.70

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 3.83 changed to 3.73
    • Practice expense RVU 9.11 changed to 10.75
    • Malpractice RVU 0.89 changed to 0.92
    • Practice expense GPCI 0.933 changed to 0.940
    • Malpractice GPCI 0.930 changed to 0.898

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $448.84changed to$425.59

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 9.42 changed to 9.11
    • Malpractice RVU 0.93 changed to 0.89

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $441.51changed to$448.84

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $452.41changed to$441.51

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 9.45 changed to 9.42
    • Malpractice RVU 0.89 changed to 0.93
    • Practice expense GPCI 0.926 changed to 0.933
    • Malpractice GPCI 0.865 changed to 0.930

  5. January 1, 2023

    RVU23A

    $457.69changed to$452.41

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense GPCI 0.919 changed to 0.926
    • Malpractice GPCI 0.799 changed to 0.865

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $464.50changed to$457.69

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 9.57 changed to 9.45
    • Malpractice RVU 0.86 changed to 0.89

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $463.50changed to$464.50

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 8.85 changed to 9.57
    • Practice expense GPCI 0.923 changed to 0.919
    • Malpractice GPCI 0.982 changed to 0.799

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $468.29changed to$463.50

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 8.83 changed to 8.85
    • Malpractice RVU 0.84 changed to 0.86
    • Practice expense GPCI 0.927 changed to 0.923
    • Malpractice GPCI 1.165 changed to 0.982

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $469.87changed to$468.29

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 8.88 changed to 8.83
    • Malpractice RVU 0.85 changed to 0.84

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $463.86changed to$469.87

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 8.76 changed to 8.88
    • Practice expense GPCI 0.925 changed to 0.927
    • Malpractice GPCI 1.167 changed to 1.165

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $461.32changed to$463.86

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 8.73 changed to 8.76
    • Malpractice RVU 0.86 changed to 0.85
    • Practice expense GPCI 0.922 changed to 0.925
    • Malpractice GPCI 1.169 changed to 1.167

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $462.47changed to$461.32

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 8.74 changed to 8.73
    • Malpractice RVU 0.84 changed to 0.86

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $460.17changed to$462.47

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $451.50changed to$460.17

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 8.62 changed to 8.74
    • Malpractice RVU 0.75 changed to 0.84
    • Practice expense GPCI 0.919 changed to 0.922
    • Malpractice GPCI 1.136 changed to 1.169

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $464.04changed to$451.50

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 9.77 changed to 8.62
    • Malpractice RVU 0.78 changed to 0.75
    • Practice expense GPCI 0.916 changed to 0.919
    • Malpractice GPCI 1.102 changed to 1.136

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $464.04

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$489.70$303.51RVU26D
2026-07-01$489.70$303.51RVU26C
2026-04-01$489.70$303.51RVU26B
2026-01-01$489.70$303.51RVU26A
2025-10-01$425.59$296.43RVU25D
2025-07-01$425.59$296.43RVU25C
2025-04-01$425.59$296.43RVU25B
2025-01-01$425.59$296.43RVU25A
2024-10-01$448.84$304.11RVU24D
2024-07-01$448.84$304.11RVU24C
2024-04-01$448.84$304.11RVU24B
2024-03-09$448.84$304.11RVU24AR
2024-01-01$441.51$299.15RVU24A
2023-10-01$452.41$303.36RVU23D
2023-07-01$452.41$303.36RVU23C
2023-04-01$452.41$303.36RVU23B
2023-01-01$452.41$303.36RVU23A
2022-10-01$457.69$303.13RVU22D
2022-07-01$457.69$303.13RVU22C
2022-04-01$457.69$303.13RVU22B
2022-01-01$457.69$303.13RVU22A
2021-10-01$464.50$301.92RVU21D
2021-07-01$464.50$301.92RVU21C
2021-04-01$464.50$301.92RVU21B
2021-01-01$464.50$301.92RVU21A
2020-10-01$463.50$309.94RVU20D
2020-07-01$463.50$309.94RVU20C
2020-04-01$463.50$309.94RVU20B
2020-01-01$463.50$309.94RVU20A
2019-10-01$468.29$312.61RVU19D
2019-07-01$468.29$312.61RVU19C
2019-04-01$468.29$312.61RVU19B
2019-01-01$468.29$312.61RVU19A
2018-10-01$469.87$312.02RVU18D
2018-07-01$469.87$312.02RVU18C
2018-04-01$469.87$312.02RVU18B
2018-01-01$469.87$312.02RVU18AR1
2017-10-01$463.86$309.16RVU17D
2017-07-01$463.86$309.16RVU17C
2017-04-01$463.86$309.16RVU17B
2017-01-01$463.86$309.16RVU17A
2016-10-01$461.32$307.81RVU16D
2016-07-01$461.32$307.81RVU16C
2016-04-01$461.32$307.81RVU16B
2016-01-01$461.32$307.81RVU16A
2015-10-01$462.47$307.09RVU15D
2015-07-01$462.47$307.09RVU15C
2015-04-01$460.17$305.56RVU15B
2015-01-01$460.17$305.56RVU15A
2014-10-01$451.50$300.72RVU14D
2014-07-01$451.50$300.72RVU14C
2014-04-01$451.50$300.72RVU14B
2014-01-01$451.50$300.72RVU14A
2013-10-01$464.04$301.04RVU13D
2013-07-01$464.04$301.04RVU13C
2013-04-01$464.04$301.04RVU13B
2013-01-01$464.04$301.04RVU13AR

Price 19020 for an earlier date of service

Where the Utah rate applies

Utah is a Medicare payment area, not a city. Our Census mapping connects it to 334 cities and communities in Utah. Some span more than one payment area; confirm with the service ZIP.

  • Alpine
  • Alta
  • Altamont
  • Alton
  • Amalga
  • American Fork
  • Aneth
  • Annabella

Browse all communities in Utah

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

Show the CMS file lines behind this rate
RVUs for 19020PPRRVU2026_Oct_nonQPP.csv, line 1,657 (RVU26D)
Geographic factors for UtahGPCI2026.csv, line 104 (RVU26D)

Open CMS sourceHow we calculate rates

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