CPT code 19101: Breast biopsy, open, incisional2026 Medicare rate & RVUs

Medicare pays $350.38 for 19101 nationally in the office and $216.44 in a hospital or facility. Local office rates run $306.73–$446.40.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 19101 covers

A surgeon makes an incision in the breast and removes a tissue sample for diagnostic examination. This approach may be selected when a breast mass or other suspicious area needs tissue diagnosis and an open sample is performed instead of a percutaneous biopsy. The service is commonly performed by a breast surgeon or general surgeon in an operating room or other surgical setting, with the specimen sent for pathology examination.

Report this code for open incisional sampling, not when the procedure removes the breast lesion as a whole. The operative note should identify the breast and site, describe the open sampling approach, and document the tissue obtained. Related postoperative visits during the 10-day global period are included. For multiple procedures in one session, Medicare pays the highest-valued procedure in full and other procedures at 50%. For bilateral reporting with modifier 50, payment is 150%. Medicare does not pay an assistant at surgery for this service; 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 19101 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

19101 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 19101 rate is calculated

Each of 19101’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.

Payment rules and modifiers for 19101

19101 has a 10-day global period: related visits in that window are included in the surgery payment.

What modifiers do to the payment

When to use modifier 50

19101 compared with similar codes

How to choose

19100Breast biopsyWithout imaging guidance

19100 describes percutaneous breast sampling without imaging guidance. Choose 19101 when the surgeon obtains the sample through an incision.

19083Breast biopsyFirst lesion, ultrasound-guided

19083 is a percutaneous biopsy performed with ultrasound guidance and includes localization-device placement when performed; 19101 is an open incisional biopsy.

19120Breast lesion excisionWithout marker localization

19120 is for removal of a breast lesion. Use 19101 when the operative service is incisional sampling rather than removal of the lesion.

19125Breast lesion excisionSingle marker-localized lesion

19125 describes excision of a breast lesion identified by preoperative radiological localization. It is not the open incisional sampling represented by 19101.

Codes related to 19101

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

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

Open CMS sourceHow we calculate rates