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CPT code 19100: Breast biopsy, without imaging guidance2026 Medicare rate & RVUs in Puerto Rico

Reports a percutaneous core needle sample of a breast abnormality obtained without imaging guidance, commonly when the target can be located by palpation.

CMS RVU26DEffective Oct 1, 2026One payment locality784 Medicare services in 2024

In Puerto Rico, Medicare pays $164.41 for 19100 in the office and $61.76 when it’s performed in a hospital or facility.

$164.41Office (non-facility)
$61.76Hospital or facility
+0.7%vs the national office rate ($163.33)

Check a contract rate as a % of Medicare · 19100 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 19100 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Puerto Rico
  2. What 19100 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 19100 covers

This service obtains breast tissue by passing a biopsy needle through the skin without imaging guidance. It is commonly used to sample a palpable breast mass or other localized abnormality when the clinician can identify the target by examination. A surgeon, breast specialist, or other qualified clinician may perform it in an office, clinic, or facility; the tissue is submitted for pathologic examination.

Select this code when the biopsy is percutaneous and performed without imaging guidance, rather than an open biopsy or an image-guided biopsy. The record should identify the breast target, the percutaneous approach, and that imaging guidance was not used. The 0-day global period includes same-day preoperative and postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment is restricted; 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 Puerto Rico compares for 19100

Across 109 of 109 payment localities, the office rate for 19100 runs from $142.69 in Arkansas to $212.69 in San Benito County, CA. Puerto Rico pays $164.41. The RVUs are the same everywhere; the geographic indexes change the dollars.

19100 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$164.41
  2. Los Angeles, CA · California$182.14+$17.73
  3. Washington, DC area · District of Columbia$186.62+$22.21
  4. Miami, FL · Florida$183.24+$18.83
  5. Chicago, IL · Illinois$177.16+$12.75
  6. Manhattan, NY · New York$189.98+$25.57
  7. Alaska · Alaska$186.81+$22.40

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

Every other payment area

19100 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$144.99$56.15
ArkansasArkansas$142.69$55.47
ArizonaArizona$158.42$60.03
Bakersfield, CACalifornia$170.94$59.65
Chico, CACalifornia$170.13$58.84
El Centro, CACalifornia$170.18$58.89
Fresno, CACalifornia$170.13$58.84
Hanford, CACalifornia$170.13$58.84

19100 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.

$142.69

$191.41

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

View every state and territory as a table
19100 office rate range by state
State / territoryOffice rate rangeLocalities
AK$186.811
AL$144.991
AR$142.691
AZ$158.421
CA$170.13–$212.6929
CO$168.791
CT$174.881
DC$186.621
DE$161.181
FL$163.45–$183.243
GA$153.17–$167.262
GU$174.441
HI$174.441
IA$147.781
ID$149.101
IL$159.24–$177.164
IN$150.011
KS$147.621
KY$150.061
LA$150.04–$158.092
MA$167.89–$185.632
MD$164.27–$186.623
ME$150.59–$158.632
MI$154.89–$166.292
MN$159.521
MO$147.63–$157.983
MS$145.161
MT$163.311
NC$152.221
ND$157.381
NE$148.481
NH$166.671
NJ$176.25–$184.522
NM$156.061
NV$161.771
NY$154.76–$195.725
OH$153.681
OK$149.121
OR$159.91–$173.852
PA$153.60–$170.602
PR$164.411
RI$166.731
SC$153.321
SD$156.681
TN$148.511
TX$152.55–$168.768
UT$155.591
VA$158.48–$186.622
VI$164.411
VT$157.261
WA$167.40–$188.972
WI$151.701
WV$152.991
WY$160.731

See 19100 in every payment locality

How the 19100 rate is calculated

Each of 19100’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 · 19100

RVUs × geographic indexes × conversion factor

Office or facility?

Work1.24

1.24 RVUs× 1.000 GPCI

Practice expense3.35

3.35 RVUs× 1.000 GPCI

Malpractice0.30

0.30 RVUs× 1.000 GPCI

Adjusted RVUs

4.8900

Conversion factor

$33.4009

Medicare rate

$163.33

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

The exact Puerto Rico inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

1,665

Code
19100
Physician work
1.24
Practice expense
3.35
Malpractice
0.30

GPCI2026.csv

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 19100 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work1.24× 1.0001.2400
Practice expense3.35× 1.0113.3868
Malpractice0.30× 0.9850.2955
Total RVUs4.9223
Conversion factor× 33.4009

Office rate, Puerto Rico$164.41

Office: (1.24 × 1 + 3.35 × 1.011 + 0.3 × 0.985) × $33.4009 = $164.41

Facility: (1.24 × 1 + 0.31 × 1.011 + 0.3 × 0.985) × $33.4009 = $61.76

Open 19100 in the RVU calculator

Payment rules and modifiers for 19100

The CMS indicators that decide how 19100 is paid alongside other services.

CMS payment indicators · 19100

Breast biopsy, without imaging guidance

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is 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.

What modifiers do to the payment

Modifier 50 · payment effect

With and without the modifier

19100 without 50 · national office

$163.33

Breast biopsy, without imaging guidance

19100-50 · Bilateral: 150%

$245.00

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 19100

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

Codes related to 19100
CodeHow it relatesOffice range, Puerto Rico
Used instead
19101Breast biopsy, open, incisionalOpen incision biopsy when tissue is obtained surgically rather than through a percutaneous needle.$352.39
19083Breast biopsy, first lesion, ultrasound-guidedUltrasound-guided percutaneous breast biopsy when ultrasound guidance is used.$479.46
19081Breast biopsy, stereotactic, first lesionStereotactic-guided breast biopsy when stereotactic imaging guides the procedure.$482.08
19085Breast biopsy, first lesion, MRI guidanceMRI-guided breast biopsy when MRI guidance is used.$725.09

How 19100 has changed in Puerto Rico

19100 · Office / nonfacility

$164.41

Effective 2026-10-01

The base rate is $22.26 higher than on 2025-10-01, moving from $142.15 to $164.41 (15.7%).

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

    $142.15changed to$164.41

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.27 changed to 1.24
    • Practice expense RVU 2.82 changed to 3.35
    • Malpractice RVU 0.29 changed to 0.30
    • Practice expense GPCI 1.007 changed to 1.011
    • Malpractice GPCI 0.982 changed to 0.985

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $149.62changed to$142.15

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 2.90 changed to 2.82
    • Malpractice RVU 0.31 changed to 0.29

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $147.18changed to$149.62

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $154.49changed to$147.18

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 2.97 changed to 2.90
    • Malpractice RVU 0.30 changed to 0.31
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $153.85changed to$154.49

    • Practice expense GPCI 1.000 changed to 1.008
    • Malpractice GPCI 1.000 changed to 0.984

  6. January 1, 2023

    RVU23A

    $161.62changed to$153.85

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 3.07 changed to 2.97
    • Malpractice RVU 0.31 changed to 0.30
    • Practice expense GPCI 1.008 changed to 1.000
    • Malpractice GPCI 0.986 changed to 1.000

    Held through RVU23B, RVU23C.

  7. January 1, 2022

    RVU22A

    $164.02changed to$161.62

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 3.11 changed to 3.07
    • Malpractice RVU 0.30 changed to 0.31

    Held through RVU22B, RVU22C, RVU22D.

  8. January 1, 2021

    RVU21A

    $159.48changed to$164.02

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 2.83 changed to 3.11
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $156.27changed to$159.48

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 2.75 changed to 2.83
    • Practice expense GPCI 1.007 changed to 1.008
    • Malpractice GPCI 0.990 changed to 0.988

    Held through RVU20B, RVU20C, RVU20D.

  10. January 1, 2019

    RVU19A

    $155.02changed to$156.27

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 2.73 changed to 2.75
    • Malpractice RVU 0.29 changed to 0.30

    Held through RVU19B, RVU19C, RVU19D.

  11. January 1, 2018

    RVU18AR1

    $135.82changed to$155.02

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 2.72 changed to 2.73
    • Practice expense GPCI 0.856 changed to 1.007
    • Malpractice GPCI 0.642 changed to 0.990

    Held through RVU18B, RVU18C, RVU18D.

  12. January 1, 2017

    RVU17A

    $117.17changed to$135.82

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense GPCI 0.705 changed to 0.856
    • Malpractice GPCI 0.293 changed to 0.642

    Held through RVU17B, RVU17C, RVU17D.

  13. January 1, 2016

    RVU16A

    $118.21changed to$117.17

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 2.74 changed to 2.72
    • Malpractice RVU 0.30 changed to 0.29

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $117.62changed to$118.21

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $114.85changed to$117.62

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 2.70 changed to 2.74
    • Malpractice RVU 0.25 changed to 0.30
    • Practice expense GPCI 0.692 changed to 0.705
    • Malpractice GPCI 0.271 changed to 0.293

    Held through RVU15B.

  16. January 1, 2014

    RVU14A

    $115.54changed to$114.85

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 3.04 changed to 2.70
    • Malpractice RVU 0.26 changed to 0.25
    • Practice expense GPCI 0.678 changed to 0.692
    • Malpractice GPCI 0.249 changed to 0.271

    Held through RVU14B, RVU14C, RVU14D.

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: $115.54

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$164.41$61.76RVU26D
2026-07-01$164.41$61.76RVU26C
2026-04-01$164.41$61.76RVU26B
2026-01-01$164.41$61.76RVU26A
2025-10-01$142.15$66.25RVU25D
2025-07-01$142.15$66.25RVU25C
2025-04-01$142.15$66.25RVU25B
2025-01-01$142.15$66.25RVU25A
2024-10-01$149.62$68.50RVU24D
2024-07-01$149.62$68.50RVU24C
2024-04-01$149.62$68.50RVU24B
2024-03-09$149.62$68.50RVU24AR
2024-01-01$147.18$67.38RVU24A
2023-10-01$154.49$69.44RVU23D
2023-07-01$153.85$69.47RVU23C
2023-04-01$153.85$69.47RVU23B
2023-01-01$153.85$69.47RVU23A
2022-10-01$161.62$71.27RVU22D
2022-07-01$161.62$71.27RVU22C
2022-04-01$161.62$71.27RVU22B
2022-01-01$161.62$71.27RVU22A
2021-10-01$164.02$71.52RVU21D
2021-07-01$164.02$71.52RVU21C
2021-04-01$164.02$71.52RVU21B
2021-01-01$164.02$71.52RVU21A
2020-10-01$159.48$73.63RVU20D
2020-07-01$159.48$73.63RVU20C
2020-04-01$159.48$73.63RVU20B
2020-01-01$159.48$73.63RVU20A
2019-10-01$156.27$73.17RVU19D
2019-07-01$156.27$73.17RVU19C
2019-04-01$156.27$73.17RVU19B
2019-01-01$156.27$73.17RVU19A
2018-10-01$155.02$72.73RVU18D
2018-07-01$155.02$72.73RVU18C
2018-04-01$155.02$72.73RVU18B
2018-01-01$155.02$72.73RVU18AR1
2017-10-01$135.82$66.39RVU17D
2017-07-01$135.82$66.39RVU17C
2017-04-01$135.82$66.39RVU17B
2017-01-01$135.82$66.39RVU17A
2016-10-01$117.17$60.13RVU16D
2016-07-01$117.17$60.13RVU16C
2016-04-01$117.17$60.13RVU16B
2016-01-01$117.17$60.13RVU16A
2015-10-01$118.21$60.45RVU15D
2015-07-01$118.21$60.45RVU15C
2015-04-01$117.62$60.15RVU15B
2015-01-01$117.62$60.15RVU15A
2014-10-01$114.85$59.33RVU14D
2014-07-01$114.85$59.33RVU14C
2014-04-01$114.85$59.33RVU14B
2014-01-01$114.85$59.33RVU14A
2013-10-01$115.54$56.95RVU13D
2013-07-01$115.54$56.95RVU13C
2013-04-01$115.54$56.95RVU13B
2013-01-01$115.54$56.95RVU13AR

Price 19100 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

  • Aceitunas
  • Adjuntas
  • Aguada
  • Aguadilla
  • Aguas Buenas
  • Aguas Claras
  • Aguilita
  • Aibonito

Browse all communities in Puerto Rico

19100 billing questions

How does this differ from an open breast biopsy?

This code describes tissue sampling through the skin with a needle and no imaging guidance. An open biopsy involves an incision to obtain tissue and is reported with 19101.

Can this code be used when imaging guides the needle?

No. Choose the applicable image-guided breast biopsy code when imaging guidance is used; for example, 19083 includes ultrasound guidance.

What documentation supports reporting 19100?

Document the breast target, the percutaneous needle approach, and that imaging guidance was not used. The record should also support that tissue was obtained for examination.

How is bilateral performance reported?

Use modifier 50 for a bilateral procedure; CMS pays the bilateral service at 150%. Same-session procedures are subject to the standard multiple procedure reduction.

Can an assistant or co-surgeon be billed?

Assistant-at-surgery payment is restricted for this code. Co-surgeons and team surgery are not permitted.

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 19100PPRRVU2026_Oct_nonQPP.csv, line 1,665 (RVU26D)
Geographic factors for Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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