CPT code 19100: Breast biopsy, without imaging guidance2026 Medicare rate & RVUs in Texas
Reports a percutaneous core needle sample of a breast abnormality obtained without imaging guidance, commonly when the target can be located by palpation.
Medicare pays $152.55–$168.76 for 19100 in the office in Texas, from Beaumont, TX to Austin, TX. 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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On this page 9 sections
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.
Where 19100 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 payment localities
$152.55 to $168.76
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin, TX | $168.76 | $61.33 |
| Beaumont, TX | $152.55 | $60.15 |
| Brazoria, TX | $160.45 | $59.83 |
| Dallas, TX | $161.83 | $60.70 |
| Fort Worth, TX | $160.84 | $60.73 |
| Galveston, TX | $161.16 | $60.33 |
| Houston, TX | $166.65 | $65.82 |
| Rest of Texas | $156.65 | $60.29 |
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
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.
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
| 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) | 1 | Not paid (statutory restriction). |
| 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
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).
19100 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 19101Breast biopsyOpen, incisional
- Use 19100 for percutaneous needle sampling without imaging guidance. Use 19101 when tissue is obtained through an open incision.
- 19083Breast biopsyFirst lesion, ultrasound-guided
- Use 19083 when ultrasound guides the percutaneous biopsy. Use 19100 when the needle is placed without imaging guidance.
- 19081Breast biopsyStereotactic, first lesion
- Use 19081 when stereotactic imaging guides the biopsy; 19100 describes needle biopsy without imaging guidance.
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
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