CPT code 19085: Breast biopsy, first lesion, MRI guidance2026 Medicare rate & RVUs in Alabama
Reports percutaneous tissue sampling of a breast lesion targeted with MRI, for the first lesion biopsied using MRI guidance.
In Alabama, Medicare pays $640.15 for 19085 in the office and $143.60 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 19085 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
What 19085 covers
This service covers percutaneous sampling of a breast lesion located and targeted with magnetic resonance imaging, typically when the lesion is not adequately accessible for targeting by ultrasound or mammography. A radiologist or other qualified breast imager guides a biopsy needle to the lesion, obtains tissue, and may place a marker clip and image the specimen. The code represents the biopsy with MRI guidance, not a diagnostic breast MRI alone or surgical removal of the lesion.
Report 19085 for the first lesion sampled with MRI guidance; report 19086 for each additional lesion sampled with that guidance. The record should support the targeted lesion, MRI guidance, tissue sampling, and any marker placement or specimen imaging performed. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. In a same-session multiple-procedure claim, the highest-valued procedure is paid in full and others at 50%; bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment requires documented medical necessity; 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 Alabama compares for 19085
Across 109 of 109 payment localities, the office rate for 19085 runs from $630.14 in Arkansas to $986.53 in San Benito County, CA. Alabama pays $640.15. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Alabama · this page$640.15
- Los Angeles, CA · California$827.42+$187.27
- Washington, DC area · District of Columbia$831.27+$191.12
- Miami, FL · Florida$760.79+$120.64
- Chicago, IL · Illinois$737.70+$97.55
- Manhattan, NY · New York$828.57+$188.42
- Alaska · Alaska$811.08+$170.93
Other areas in Alabama first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| ArkansasArkansas | $630.14 | $142.67 |
| ArizonaArizona | $698.86 | $148.97 |
| Bakersfield, CACalifornia | $772.97 | $151.01 |
| Chico, CACalifornia | $771.88 | $149.92 |
| El Centro, CACalifornia | $771.94 | $149.98 |
| Fresno, CACalifornia | $771.88 | $149.92 |
| Hanford, CACalifornia | $771.88 | $149.92 |
| Madera, CACalifornia | $771.88 | $149.92 |
| Merced, CACalifornia | $771.88 | $149.92 |
| Modesto, CACalifornia | $771.88 | $149.92 |
| Napa, CACalifornia | $907.66 | $159.72 |
| Oxnard, CACalifornia | $824.81 | $154.05 |
| Redding, CACalifornia | $771.88 | $149.92 |
| Rest of CaliforniaCalifornia | $771.88 | $149.92 |
| Riverside, CACalifornia | $775.70 | $153.74 |
| Sacramento, CACalifornia | $813.56 | $153.58 |
| Salinas, CACalifornia | $810.61 | $152.90 |
| San Diego, CACalifornia | $832.34 | $153.63 |
| Marin County, CACalifornia | $965.02 | $164.87 |
| San Francisco, CACalifornia | $964.62 | $164.48 |
| San Benito County, CACalifornia | $986.53 | $168.23 |
| Santa Clara County, CACalifornia | $984.91 | $166.60 |
| San Luis Obispo, CACalifornia | $797.18 | $150.82 |
| Santa Cruz, CACalifornia | $842.39 | $152.90 |
| Santa Maria, CACalifornia | $814.38 | $152.69 |
| Santa Rosa, CACalifornia | $851.10 | $154.24 |
| Stockton, CACalifornia | $771.88 | $149.92 |
| Vallejo, CACalifornia | $907.08 | $159.14 |
| Visalia, CACalifornia | $771.88 | $149.92 |
| Yuba City, CACalifornia | $771.88 | $149.92 |
| ColoradoColorado | $755.32 | $151.52 |
| ConnecticutConnecticut | $768.93 | $157.75 |
| DelawareDelaware | $711.14 | $150.47 |
| Fort Lauderdale, FLFlorida | $735.88 | $161.03 |
| Rest of FloridaFlorida | $698.77 | $156.26 |
| Atlanta, GAGeorgia | $730.91 | $154.35 |
| Rest of GeorgiaGeorgia | $657.47 | $151.28 |
| Hawaii, Guam, HIHawaii | $794.49 | $149.27 |
| IowaIowa | $661.71 | $142.47 |
| IdahoIdaho | $665.54 | $143.46 |
| East St. Louis, ILIllinois | $683.56 | $161.48 |
| Rest of IllinoisIllinois | $674.17 | $156.06 |
| Suburban Chicago, ILIllinois | $744.53 | $161.73 |
| IndianaIndiana | $669.82 | $143.76 |
| KansasKansas | $656.49 | $143.49 |
| KentuckyKentucky | $652.47 | $147.98 |
| New Orleans, LALouisiana | $685.65 | $151.65 |
| Rest of LouisianaLouisiana | $650.62 | $148.40 |
| Metropolitan Boston, MAMassachusetts | $836.54 | $158.96 |
| Rest of MassachusettsMassachusetts | $749.50 | $151.95 |
| Baltimore area, MDMaryland | $766.42 | $157.51 |
| Rest of MarylandMaryland | $726.08 | $151.79 |
| Rest of MaineMaine | $667.29 | $145.20 |
| Southern Maine, MEMaine | $709.18 | $146.80 |
| Detroit, MIMichigan | $706.21 | $158.59 |
| Rest of MichiganMichigan | $669.09 | $150.98 |
| MinnesotaMinnesota | $727.62 | $143.69 |
| Metropolitan Kansas City, MOMissouri | $682.62 | $149.75 |
| Metropolitan St. Louis, MOMissouri | $690.56 | $150.32 |
| Rest of MissouriMissouri | $637.27 | $148.10 |
| MississippiMississippi | $633.93 | $145.33 |
| MontanaMontana | $718.76 | $151.28 |
| North CarolinaNorth Carolina | $675.14 | $145.68 |
| North DakotaNorth Dakota | $711.84 | $144.36 |
| NebraskaNebraska | $666.20 | $142.41 |
| New HampshireNew Hampshire | $741.46 | $150.71 |
| Northern New JerseyNew Jersey | $821.22 | $162.94 |
| Rest of New JerseyNew Jersey | $778.81 | $159.12 |
| New MexicoNew Mexico | $672.29 | $151.91 |
| NevadaNevada | $717.42 | $149.37 |
| NYC suburbs and Long Island, NYNew York | $847.63 | $172.89 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $782.49 | $161.10 |
| Queens, NYNew York | $838.65 | $167.89 |
| Rest of New YorkNew York | $685.89 | $146.78 |
| OhioOhio | $667.68 | $149.57 |
| OklahomaOklahoma | $653.21 | $146.45 |
| Portland, OROregon | $783.02 | $152.55 |
| Rest of OregonOregon | $712.96 | $147.75 |
| Metropolitan Philadelphia, PAPennsylvania | $747.31 | $156.56 |
| Rest of PennsylvaniaPennsylvania | $669.89 | $148.94 |
| Puerto RicoPuerto Rico | $725.09 | $151.36 |
| Rhode IslandRhode Island | $739.20 | $152.99 |
| South CarolinaSouth Carolina | $672.31 | $147.95 |
| South DakotaSouth Dakota | $711.02 | $143.54 |
| TennesseeTennessee | $659.82 | $143.98 |
| Austin, TXTexas | $751.83 | $151.43 |
| Beaumont, TXTexas | $664.99 | $148.58 |
| Brazoria, TXTexas | $711.87 | $149.49 |
| Dallas, TXTexas | $715.84 | $150.63 |
| Fort Worth, TXTexas | $710.11 | $150.57 |
| Galveston, TXTexas | $713.61 | $150.10 |
| Houston, TXTexas | $720.01 | $156.50 |
| Rest of TexasTexas | $687.64 | $149.10 |
| UtahUtah | $682.28 | $148.85 |
| VirginiaVirginia | $705.35 | $147.51 |
| Virgin Islands, VIUnited States Virgin Islands | $725.09 | $151.36 |
| VermontVermont | $707.13 | $145.32 |
| Rest of WashingtonWashington | $748.73 | $151.17 |
| King County, WAWashington | $856.17 | $159.87 |
| WisconsinWisconsin | $685.98 | $142.33 |
| West VirginiaWest Virginia | $646.73 | $153.59 |
| WyomingWyoming | $715.75 | $148.27 |
19085 rates by state
Office rate range in each state. Select a state to see its payment localities.
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.
$630.14
$879.20
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $811.08 | 1 |
| AL | $640.15 | 1 |
| AR | $630.14 | 1 |
| AZ | $698.86 | 1 |
| CA | $771.88–$986.53 | 29 |
| CO | $755.32 | 1 |
| CT | $768.93 | 1 |
| DC | $831.27 | 1 |
| DE | $711.14 | 1 |
| FL | $698.77–$760.79 | 3 |
| GA | $657.47–$730.91 | 2 |
| GU | $794.49 | 1 |
| HI | $794.49 | 1 |
| IA | $661.71 | 1 |
| ID | $665.54 | 1 |
| IL | $674.17–$744.53 | 4 |
| IN | $669.82 | 1 |
| KS | $656.49 | 1 |
| KY | $652.47 | 1 |
| LA | $650.62–$685.65 | 2 |
| MA | $749.50–$836.54 | 2 |
| MD | $726.08–$831.27 | 3 |
| ME | $667.29–$709.18 | 2 |
| MI | $669.09–$706.21 | 2 |
| MN | $727.62 | 1 |
| MO | $637.27–$690.56 | 3 |
| MS | $633.93 | 1 |
| MT | $718.76 | 1 |
| NC | $675.14 | 1 |
| ND | $711.84 | 1 |
| NE | $666.20 | 1 |
| NH | $741.46 | 1 |
| NJ | $778.81–$821.22 | 2 |
| NM | $672.29 | 1 |
| NV | $717.42 | 1 |
| NY | $685.89–$847.63 | 5 |
| OH | $667.68 | 1 |
| OK | $653.21 | 1 |
| OR | $712.96–$783.02 | 2 |
| PA | $669.89–$747.31 | 2 |
| PR | $725.09 | 1 |
| RI | $739.20 | 1 |
| SC | $672.31 | 1 |
| SD | $711.02 | 1 |
| TN | $659.82 | 1 |
| TX | $664.99–$751.83 | 8 |
| UT | $682.28 | 1 |
| VA | $705.35–$831.27 | 2 |
| VI | $725.09 | 1 |
| VT | $707.13 | 1 |
| WA | $748.73–$856.17 | 2 |
| WI | $685.98 | 1 |
| WV | $646.73 | 1 |
| WY | $715.75 | 1 |
How the 19085 rate is calculated
Each of 19085’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 · 19085
RVUs × geographic indexes × conversion factor
Work3.55
3.55 RVUs× 1.000 GPCI
Practice expense17.62
17.62 RVUs× 1.000 GPCI
Malpractice0.35
0.35 RVUs× 1.000 GPCI
Adjusted RVUs
21.5200
Conversion factor
$33.4009
Medicare rate
$718.79
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Alabama inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
1,663
- Code
- 19085
- Physician work
- 3.55
- Practice expense
- 17.62
- Malpractice
- 0.35
GPCI2026.csv
4
- Locality
- Alabama
- Physician work
- 1.000
- Practice expense
- 0.875
- Malpractice
- 0.566
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.55 | × 1.000 | 3.5500 |
| Practice expense | 17.62 | × 0.875 | 15.4175 |
| Malpractice | 0.35 | × 0.566 | 0.1981 |
| Total RVUs | 19.1656 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Alabama$640.15
Office: (3.55 × 1 + 17.62 × 0.875 + 0.35 × 0.566) × $33.4009 = $640.15
Facility: (3.55 × 1 + 0.63 × 0.875 + 0.35 × 0.566) × $33.4009 = $143.60
Payment rules and modifiers for 19085
The CMS indicators that decide how 19085 is paid alongside other services.
CMS payment indicators · 19085
Breast biopsy, first lesion, MRI guidance
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is 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) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
19085 without 50 · national office
$718.79
Breast biopsy, first lesion, MRI guidance
19085-50 · Bilateral: 150%
$1,078.19
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).
How 19085 has changed in Alabama
19085 · Office / nonfacility
$640.15
Effective 2026-10-01
The base rate is $9.18 higher than on 2025-10-01, moving from $630.97 to $640.15 (1.5%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
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
January 1, 2026
RVU26A
$630.97changed to$640.15
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 3.64 changed to 3.55
- Practice expense RVU 18.04 changed to 17.62
- Malpractice RVU 0.33 changed to 0.35
- Practice expense GPCI 0.869 changed to 0.875
- Malpractice GPCI 0.575 changed to 0.566
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$668.41changed to$630.97
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 18.70 changed to 18.04
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$657.51changed to$668.41
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$707.22changed to$657.51
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 19.36 changed to 18.70
- Malpractice RVU 0.31 changed to 0.33
- Practice expense GPCI 0.878 changed to 0.869
- Malpractice GPCI 0.748 changed to 0.575
January 1, 2023
RVU23A
$747.99changed to$707.22
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 19.92 changed to 19.36
- Practice expense GPCI 0.888 changed to 0.878
- Malpractice GPCI 0.921 changed to 0.748
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$818.63changed to$747.99
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 22.01 changed to 19.92
- Malpractice RVU 0.30 changed to 0.31
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$852.56changed to$818.63
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 22.24 changed to 22.01
- Practice expense GPCI 0.889 changed to 0.888
- Malpractice GPCI 0.707 changed to 0.921
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$888.37changed to$852.56
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 23.43 changed to 22.24
- Malpractice RVU 0.32 changed to 0.30
- Practice expense GPCI 0.890 changed to 0.889
- Malpractice GPCI 0.492 changed to 0.707
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$923.74changed to$888.37
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 24.57 changed to 23.43
- Malpractice RVU 0.31 changed to 0.32
Held through RVU19B, RVU19C, RVU19D.
April 1, 2018
RVU18B
No ratechanged to$923.74
Held through RVU18C, RVU18D.
January 1, 2014
RVU14A
No ratechanged toNo rate
Held through RVU14B, RVU14C, RVU14D, RVU15A, RVU15B, RVU15C, RVU15D, RVU16A, RVU16B, RVU16C, RVU16D, RVU17A, RVU17B, RVU17C, RVU17D, RVU18AR1.
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $640.15 | $143.60 | RVU26D |
| 2026-07-01 | $640.15 | $143.60 | RVU26C |
| 2026-04-01 | $640.15 | $143.60 | RVU26B |
| 2026-01-01 | $640.15 | $143.60 | RVU26A |
| 2025-10-01 | $630.97 | $161.26 | RVU25D |
| 2025-07-01 | $630.97 | $161.26 | RVU25C |
| 2025-04-01 | $630.97 | $161.26 | RVU25B |
| 2025-01-01 | $630.97 | $161.26 | RVU25A |
| 2024-10-01 | $668.41 | $164.80 | RVU24D |
| 2024-07-01 | $668.41 | $164.80 | RVU24C |
| 2024-04-01 | $668.41 | $164.80 | RVU24B |
| 2024-03-09 | $668.41 | $164.80 | RVU24AR |
| 2024-01-01 | $657.51 | $162.11 | RVU24A |
| 2023-10-01 | $707.22 | $170.48 | RVU23D |
| 2023-07-01 | $707.22 | $170.48 | RVU23C |
| 2023-04-01 | $707.22 | $170.48 | RVU23B |
| 2023-01-01 | $707.22 | $170.48 | RVU23A |
| 2022-10-01 | $747.99 | $176.10 | RVU22D |
| 2022-07-01 | $747.99 | $176.10 | RVU22C |
| 2022-04-01 | $747.99 | $176.10 | RVU22B |
| 2022-01-01 | $747.99 | $176.10 | RVU22A |
| 2021-10-01 | $818.63 | $177.55 | RVU21D |
| 2021-07-01 | $818.63 | $177.55 | RVU21C |
| 2021-04-01 | $818.63 | $177.55 | RVU21B |
| 2021-01-01 | $818.63 | $177.55 | RVU21A |
| 2020-10-01 | $852.56 | $182.01 | RVU20D |
| 2020-07-01 | $852.56 | $182.01 | RVU20C |
| 2020-04-01 | $852.56 | $182.01 | RVU20B |
| 2020-01-01 | $852.56 | $182.01 | RVU20A |
| 2019-10-01 | $888.37 | $179.84 | RVU19D |
| 2019-07-01 | $888.37 | $179.84 | RVU19C |
| 2019-04-01 | $888.37 | $179.84 | RVU19B |
| 2019-01-01 | $888.37 | $179.84 | RVU19A |
| 2018-10-01 | $923.74 | $179.46 | RVU18D |
| 2018-07-01 | $923.74 | $179.46 | RVU18C |
| 2018-04-01 | $923.74 | $179.46 | RVU18B |
| 2018-01-01 | Rate data unavailable | Rate data unavailable | RVU18AR1 |
| 2017-10-01 | Rate data unavailable | Rate data unavailable | RVU17D |
| 2017-07-01 | Rate data unavailable | Rate data unavailable | RVU17C |
| 2017-04-01 | Rate data unavailable | Rate data unavailable | RVU17B |
| 2017-01-01 | Rate data unavailable | Rate data unavailable | RVU17A |
| 2016-10-01 | Rate data unavailable | Rate data unavailable | RVU16D |
| 2016-07-01 | Rate data unavailable | Rate data unavailable | RVU16C |
| 2016-04-01 | Rate data unavailable | Rate data unavailable | RVU16B |
| 2016-01-01 | Rate data unavailable | Rate data unavailable | RVU16A |
| 2015-10-01 | Rate data unavailable | Rate data unavailable | RVU15D |
| 2015-07-01 | Rate data unavailable | Rate data unavailable | RVU15C |
| 2015-04-01 | Rate data unavailable | Rate data unavailable | RVU15B |
| 2015-01-01 | Rate data unavailable | Rate data unavailable | RVU15A |
| 2014-10-01 | Rate data unavailable | Rate data unavailable | RVU14D |
| 2014-07-01 | Rate data unavailable | Rate data unavailable | RVU14C |
| 2014-04-01 | Rate data unavailable | Rate data unavailable | RVU14B |
| 2014-01-01 | Rate data unavailable | Rate data unavailable | RVU14A |
| 2013-10-01 | Not in this release | Not in this release | RVU13D |
| 2013-07-01 | Not in this release | Not in this release | RVU13C |
| 2013-04-01 | Not in this release | Not in this release | RVU13B |
| 2013-01-01 | Not in this release | Not in this release | RVU13AR |
Where the Alabama rate applies
Alabama is a Medicare payment area, not a city. Our Census mapping connects it to 595 cities and communities in Alabama. Some span more than one payment area; confirm with the service ZIP.
- Abanda
- Abbeville
- Adamsville
- Addison
- Akron
- Alabaster
- Albertville
- Alexander City
19085 billing questions
When is 19085 used instead of 19083?
Use 19085 when MRI guides the percutaneous breast biopsy. Use 19083 when ultrasound provides the guidance.
How is a second MRI-guided lesion reported?
Report 19086 for each additional lesion sampled with MRI guidance, along with 19085 for the first lesion.
Are marker placement and specimen imaging separately reported?
Marker placement and imaging of the biopsy specimen are included in 19085 when performed; they are not separate services under this code.
How should bilateral MRI-guided biopsies be reported?
CMS identifies this as a bilateral procedure; modifier 50 is paid at 150%. Document the biopsies performed on both breasts.
What documentation supports 19085?
Document the breast lesion targeted, MRI guidance, and percutaneous tissue sampling. Record marker placement and specimen imaging when performed.
Can an assistant or co-surgeon be billed?
Assistant-at-surgery payment requires documentation of medical necessity. CMS does not permit co-surgeons or team surgery for this code.
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
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