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CPT code 19086: Breast biopsy, additional MRI-guided lesion2026 Medicare rate & RVUs in Delaware

Report this add-on for tissue sampling of an additional breast lesion using MRI guidance, alongside the primary MRI-guided breast biopsy code.

CMS RVU26DEffective Oct 1, 2026One payment locality1.6K Medicare services in 2024

In Delaware, Medicare pays $546.98 for 19086 in the office and $75.08 when it’s performed in a hospital or facility.

$546.98Office (non-facility)
$75.08Hospital or facility
−1.1%vs the national office rate ($553.12)

Check a contract rate as a % of Medicare · 19086 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 19086 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Delaware
  2. What 19086 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 19086 covers

This code covers needle sampling of an additional breast target identified and accessed with MRI guidance. It is typically performed by a radiologist or other qualified breast-imaging clinician in an outpatient imaging center or hospital MRI suite. The biopsy may include placement of a marker at the sampled site and imaging of the specimen when performed. The first MRI-guided lesion is reported separately with the primary code.

Report one unit for each additional lesion sampled under MRI guidance, supported by documentation identifying the targets and confirming MRI guidance and tissue sampling. Do not use this code by itself: it is an add-on reported with the primary MRI-guided breast biopsy procedure. Under the CMS rule for this code, payment is within the primary procedure’s global period. The documentation should distinguish each additional target from the first lesion and from targets sampled using another guidance method.

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 Delaware compares for 19086

Across 109 of 109 payment localities, the office rate for 19086 runs from $481.51 in Arkansas to $772.83 in San Benito County, CA. Delaware pays $546.98. The RVUs are the same everywhere; the geographic indexes change the dollars.

19086 in Delaware vs other payment areas
  1. Delaware · this page$546.98
  2. Los Angeles, CA · California$643.00+$96.02
  3. Washington, DC area · District of Columbia$643.87+$96.89
  4. Miami, FL · Florida$581.82+$34.84
  5. Chicago, IL · Illinois$563.33+$16.35
  6. Manhattan, NY · New York$639.34+$92.36
  7. Alaska · Alaska$611.87+$64.89

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

Every other payment area

19086 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$489.61$71.69
ArkansasArkansas$481.51$71.23
ArizonaArizona$537.16$74.34
Bakersfield, CACalifornia$598.90$75.42
Chico, CACalifornia$598.37$74.88
El Centro, CACalifornia$598.40$74.91
Fresno, CACalifornia$598.37$74.88
Hanford, CACalifornia$598.37$74.88

19086 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.

$481.51

$685.60

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

View every state and territory as a table
19086 office rate range by state
State / territoryOffice rate rangeLocalities
AK$611.871
AL$489.611
AR$481.511
AZ$537.161
CA$598.37–$772.8329
CO$583.841
CT$593.091
DC$643.871
DE$546.981
FL$534.49–$581.823
GA$501.47–$562.252
GU$617.631
HI$617.631
IA$508.191
ID$511.061
IL$513.83–$571.104
IN$514.551
KS$503.421
KY$498.431
LA$496.72–$525.082
MA$578.79–$649.652
MD$559.10–$643.873
ME$511.91–$546.632
MI$511.37–$539.922
MN$563.281
MO$485.58–$529.693
MS$483.761
MT$553.111
NC$518.351
ND$549.751
NE$511.991
NH$572.431
NJ$600.96–$635.362
NM$513.731
NV$552.661
NY$527.02–$654.065
OH$510.681
OK$499.601
OR$549.48–$606.812
PA$512.76–$575.302
PR$558.411
RI$569.741
SC$515.151
SD$549.351
TN$506.051
TX$508.77–$580.918
UT$523.241
VA$543.15–$643.872
VI$558.411
VT$545.431
WA$578.41–$665.882
WI$528.681
WV$491.601
WY$551.641

See 19086 in every payment locality

How the 19086 rate is calculated

Each of 19086’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 · 19086

RVUs × geographic indexes × conversion factor

Office or facility?

Work1.77

1.77 RVUs× 1.000 GPCI

Practice expense14.62

14.62 RVUs× 1.000 GPCI

Malpractice0.17

0.17 RVUs× 1.000 GPCI

Adjusted RVUs

16.5600

Conversion factor

$33.4009

Medicare rate

$553.12

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Delaware inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

1,664

Code
19086
Physician work
1.77
Practice expense
14.62
Malpractice
0.17

GPCI2026.csv

40

Locality
Delaware
Physician work
1.005
Practice expense
0.988
Malpractice
0.899
Office calculation for 19086 in Delaware
ComponentRVULocality factorAdjusted
Physician work1.77× 1.0051.7788
Practice expense14.62× 0.98814.4446
Malpractice0.17× 0.8990.1528
Total RVUs16.3762
Conversion factor× 33.4009

Office rate, Delaware$546.98

Office: (1.77 × 1.005 + 14.62 × 0.988 + 0.17 × 0.899) × $33.4009 = $546.98

Facility: (1.77 × 1.005 + 0.32 × 0.988 + 0.17 × 0.899) × $33.4009 = $75.08

Open 19086 in the RVU calculator

Payment rules and modifiers for 19086

The CMS indicators that decide how 19086 is paid alongside other services.

CMS payment indicators · 19086

Breast biopsy, additional MRI-guided lesion

RuleCMS valueWhat it means
Global periodZZZAdd-on code: falls within the primary procedure’s global period.
Multiple procedures0No multiple-procedure reduction.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)0Not paid without supporting documentation.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.

Codes related to 19086

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

Codes related to 19086
CodeHow it relatesOffice range, Delaware
Primary code
19085Breast biopsy, first lesion, MRI guidancePrimary MRI-guided biopsy code for the first lesion; report with 19086.$711.14
Used instead
19084Breast biopsy, additional lesion, ultrasound-guidedAdditional-lesion breast biopsy when ultrasound, rather than MRI, guides sampling.$353.48
19082Breast biopsy, additional stereotactic lesionAdditional-lesion breast biopsy when stereotactic imaging guides sampling.$359.45
19083Breast biopsy, first lesion, ultrasound-guidedPrimary breast biopsy code for ultrasound-guided sampling of the first lesion.$470.63

How 19086 has changed in Delaware

19086 · Office / nonfacility

$546.98

Effective 2026-10-01

The base rate is $2.96 higher than on 2025-10-01, moving from $544.02 to $546.98 (0.5%).

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

    $544.02changed to$546.98

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.82 changed to 1.77
    • Practice expense RVU 14.95 changed to 14.62
    • Malpractice RVU 0.16 changed to 0.17
    • Work GPCI 1.009 changed to 1.005
    • Practice expense GPCI 0.992 changed to 0.988
    • Malpractice GPCI 0.949 changed to 0.899

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $579.33changed to$544.02

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 15.54 changed to 14.95

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $569.88changed to$579.33

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $618.28changed to$569.88

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 16.14 changed to 15.54
    • Malpractice RVU 0.17 changed to 0.16
    • Work GPCI 1.007 changed to 1.009
    • Practice expense GPCI 1.007 changed to 0.992
    • Malpractice GPCI 0.938 changed to 0.949

  5. January 1, 2023

    RVU23A

    $657.01changed to$618.28

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 16.66 changed to 16.14
    • Malpractice RVU 0.14 changed to 0.17
    • Work GPCI 1.005 changed to 1.007
    • Practice expense GPCI 1.022 changed to 1.007
    • Malpractice GPCI 0.927 changed to 0.938

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $731.61changed to$657.01

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 18.59 changed to 16.66
    • Malpractice RVU 0.15 changed to 0.14

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $765.82changed to$731.61

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 18.86 changed to 18.59
    • Malpractice RVU 0.13 changed to 0.15
    • Work GPCI 1.006 changed to 1.005
    • Practice expense GPCI 1.021 changed to 1.022
    • Malpractice GPCI 1.023 changed to 0.927

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $806.61changed to$765.82

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 19.99 changed to 18.86
    • Malpractice RVU 0.16 changed to 0.13
    • Work GPCI 1.007 changed to 1.006
    • Practice expense GPCI 1.019 changed to 1.021
    • Malpractice GPCI 1.119 changed to 1.023

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $847.55changed to$806.61

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 21.13 changed to 19.99

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $851.08changed to$847.55

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 21.16 changed to 21.13
    • Malpractice RVU 0.17 changed to 0.16
    • Work GPCI 1.010 changed to 1.007
    • Practice expense GPCI 1.025 changed to 1.019
    • Malpractice GPCI 1.101 changed to 1.119

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $854.75changed to$851.08

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 21.19 changed to 21.16
    • Work GPCI 1.012 changed to 1.010
    • Practice expense GPCI 1.031 changed to 1.025
    • Malpractice GPCI 1.083 changed to 1.101

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $860.91changed to$854.75

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 21.21 changed to 21.19
    • Malpractice RVU 0.23 changed to 0.17

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $856.63changed to$860.91

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $846.13changed to$856.63

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 20.93 changed to 21.21
    • Malpractice RVU 0.06 changed to 0.23
    • Practice expense GPCI 1.038 changed to 1.031
    • Malpractice GPCI 0.878 changed to 1.083

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    No ratechanged to$846.13

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: No rate

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$546.98$75.08RVU26D
2026-07-01$546.98$75.08RVU26C
2026-04-01$546.98$75.08RVU26B
2026-01-01$546.98$75.08RVU26A
2025-10-01$544.02$85.49RVU25D
2025-07-01$544.02$85.49RVU25C
2025-04-01$544.02$85.49RVU25B
2025-01-01$544.02$85.49RVU25A
2024-10-01$579.33$87.32RVU24D
2024-07-01$579.33$87.32RVU24C
2024-04-01$579.33$87.32RVU24B
2024-03-09$579.33$87.32RVU24AR
2024-01-01$569.88$85.89RVU24A
2023-10-01$618.28$90.03RVU23D
2023-07-01$618.28$90.03RVU23C
2023-04-01$618.28$90.03RVU23B
2023-01-01$618.28$90.03RVU23A
2022-10-01$657.01$91.13RVU22D
2022-07-01$657.01$91.13RVU22C
2022-04-01$657.01$91.13RVU22B
2022-01-01$657.01$91.13RVU22A
2021-10-01$731.61$92.21RVU21D
2021-07-01$731.61$92.21RVU21C
2021-04-01$731.61$92.21RVU21B
2021-01-01$731.61$92.21RVU21A
2020-10-01$765.82$95.93RVU20D
2020-07-01$765.82$95.93RVU20C
2020-04-01$765.82$95.93RVU20B
2020-01-01$765.82$95.93RVU20A
2019-10-01$806.61$97.11RVU19D
2019-07-01$806.61$97.11RVU19C
2019-04-01$806.61$97.11RVU19B
2019-01-01$806.61$97.11RVU19A
2018-10-01$847.55$97.37RVU18D
2018-07-01$847.55$97.37RVU18C
2018-04-01$847.55$97.37RVU18B
2018-01-01$847.55$97.37RVU18AR1
2017-10-01$851.08$97.70RVU17D
2017-07-01$851.08$97.70RVU17C
2017-04-01$851.08$97.70RVU17B
2017-01-01$851.08$97.70RVU17A
2016-10-01$854.75$97.64RVU16D
2016-07-01$854.75$97.64RVU16C
2016-04-01$854.75$97.64RVU16B
2016-01-01$854.75$97.64RVU16A
2015-10-01$860.91$100.33RVU15D
2015-07-01$860.91$100.33RVU15C
2015-04-01$856.63$99.83RVU15B
2015-01-01$856.63$99.83RVU15A
2014-10-01$846.13$92.78RVU14D
2014-07-01$846.13$92.78RVU14C
2014-04-01$846.13$92.78RVU14B
2014-01-01$846.13$92.78RVU14A
2013-10-01Not in this releaseNot in this releaseRVU13D
2013-07-01Not in this releaseNot in this releaseRVU13C
2013-04-01Not in this releaseNot in this releaseRVU13B
2013-01-01Not in this releaseNot in this releaseRVU13AR

Price 19086 for an earlier date of service

Where the Delaware rate applies

Delaware is a Medicare payment area, not a city. Our Census mapping connects it to 79 cities and communities in Delaware. Some span more than one payment area; confirm with the service ZIP.

  • Arden
  • Ardencroft
  • Ardentown
  • Bear
  • Bellefonte
  • Bethany Beach
  • Bethel
  • Blades

Browse all communities in Delaware

19086 billing questions

When is this code reported instead of 19085?

Use 19085 for the first lesion sampled with MRI guidance. Report 19086 for each additional lesion sampled with MRI guidance during the procedure.

Can 19086 be billed by itself?

No. It is an add-on code and must be reported with the primary MRI-guided breast biopsy code, 19085.

How many units should be reported?

Report one unit for each additional lesion sampled. The first lesion is represented by 19085, not by an additional unit of 19086.

Is marker placement separately reported?

Marker placement at the biopsy site, when performed, is part of the MRI-guided biopsy service. Specimen imaging, when performed, is also included in the service.

How does 19086 differ from 19084?

Both represent sampling of an additional lesion, but 19086 is for MRI guidance and 19084 is for ultrasound guidance.

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 19086PPRRVU2026_Oct_nonQPP.csv, line 1,664 (RVU26D)
Geographic factors for DelawareGPCI2026.csv, line 40 (RVU26D)

Open CMS sourceHow we calculate rates

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