CPT code 19085: Breast biopsy, first lesion, MRI guidance2026 Medicare rate & RVUs in Maryland
Reports percutaneous tissue sampling of a breast lesion targeted with MRI, for the first lesion biopsied using MRI guidance.
Medicare pays $726.08–$831.27 for 19085 in the office in Maryland, from Rest of Maryland to Washington, DC area. 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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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.
Where 19085 pays more and less in Maryland
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$726.08 to $831.27
| Payment locality | Office | Facility |
|---|---|---|
| Baltimore area, MD | $766.42 | $157.51 |
| Rest of Maryland | $726.08 | $151.79 |
| Washington, DC area | $831.27 | $162.78 |
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.
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).
19085 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 19083Breast biopsyFirst lesion, ultrasound-guided
- Both cover percutaneous biopsy of the first breast lesion, but 19083 uses ultrasound guidance and 19085 uses MRI guidance.
- 19081Breast biopsyStereotactic, first lesion
- Use 19081 when stereotactic imaging guides the first lesion biopsy; use 19085 when MRI provides the guidance.
- 19086Breast biopsyAdditional MRI-guided lesion
- 19085 reports the first MRI-guided lesion. 19086 reports each additional lesion sampled with MRI guidance.
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
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