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

Reports surgical sampling of breast tissue through an incision when an open incisional biopsy is performed rather than percutaneous sampling or lesion removal.

CMS RVU26DEffective Oct 1, 2026One payment locality751 Medicare services in 2024

In Utah, Medicare pays $334.56 for 19101 in the office and $208.66 when it’s performed in a hospital or facility.

$334.56Office (non-facility)
$208.66Hospital or facility
−4.5%vs the national office rate ($350.38)

Check a contract rate as a % of Medicare · 19101 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 19101 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Utah
  2. What 19101 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 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.

How Utah compares for 19101

Across 109 of 109 payment localities, the office rate for 19101 runs from $306.73 in Arkansas to $446.40 in San Benito County, CA. Utah pays $334.56. The RVUs are the same everywhere; the geographic indexes change the dollars.

19101 in Utah vs other payment areas
  1. Utah · this page$334.56
  2. Los Angeles, CA · California$385.86+$51.30
  3. Washington, DC area · District of Columbia$397.98+$63.42
  4. Miami, FL · Florida$399.69+$65.13
  5. Chicago, IL · Illinois$386.38+$51.82
  6. Manhattan, NY · New York$408.01+$73.45
  7. Alaska · Alaska$405.35+$70.79

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

Every other payment area

19101 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$311.58$194.38
ArkansasArkansas$306.73$191.68
ArizonaArizona$339.79$210.01
Bakersfield, CACalifornia$363.06$216.26
Chico, CACalifornia$360.92$214.13
El Centro, CACalifornia$361.06$214.26
Fresno, CACalifornia$360.92$214.13
Hanford, CACalifornia$360.92$214.13

19101 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.

$306.73

$405.35

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

View every state and territory as a table
19101 office rate range by state
State / territoryOffice rate rangeLocalities
AK$405.351
AL$311.581
AR$306.731
AZ$339.791
CA$360.92–$446.4029
CO$359.861
CT$374.871
DC$397.981
DE$345.611
FL$354.02–$399.693
GA$331.81–$359.502
GU$369.241
HI$369.241
IA$315.871
ID$318.971
IL$346.20–$386.384
IN$320.841
KS$316.291
KY$323.851
LA$324.11–$341.062
MA$358.30–$394.232
MD$351.89–$397.983
ME$322.90–$338.672
MI$334.75–$360.822
MN$338.141
MO$319.50–$339.933
MS$313.081
MT$350.321
NC$326.191
ND$334.701
NE$317.121
NH$356.051
NJ$377.27–$393.802
NM$337.521
NV$346.191
NY$331.60–$421.075
OH$331.551
OK$321.081
OR$341.66–$369.592
PA$330.98–$366.332
PR$352.391
RI$356.741
SC$329.791
SD$332.851
TN$318.251
TX$328.81–$360.278
UT$334.561
VA$338.90–$397.982
VI$352.391
VT$335.151
WA$357.03–$400.472
WI$322.931
WV$333.091
WY$343.511

See 19101 in every payment locality

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.

How the rate is built · 19101

RVUs × geographic indexes × conversion factor

Office or facility?

Work3.15

3.15 RVUs× 1.000 GPCI

Practice expense6.55

6.55 RVUs× 1.000 GPCI

Malpractice0.79

0.79 RVUs× 1.000 GPCI

Adjusted RVUs

10.4900

Conversion factor

$33.4009

Medicare rate

$350.38

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

The exact Utah inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

1,666

Code
19101
Physician work
3.15
Practice expense
6.55
Malpractice
0.79

GPCI2026.csv

104

Locality
Utah
Physician work
1.000
Practice expense
0.940
Malpractice
0.898
Office calculation for 19101 in Utah
ComponentRVULocality factorAdjusted
Physician work3.15× 1.0003.1500
Practice expense6.55× 0.9406.1570
Malpractice0.79× 0.8980.7094
Total RVUs10.0164
Conversion factor× 33.4009

Office rate, Utah$334.56

Office: (3.15 × 1 + 6.55 × 0.94 + 0.79 × 0.898) × $33.4009 = $334.56

Facility: (3.15 × 1 + 2.54 × 0.94 + 0.79 × 0.898) × $33.4009 = $208.66

Open 19101 in the RVU calculator

Payment rules and modifiers for 19101

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

CMS payment indicators · 19101

Breast biopsy, open, incisional

RuleCMS valueWhat it means
Global period010Minor procedure: the day of the procedure plus 10 days after are 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.
Split (54/55/56)0.10/0.80/0.10Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 19101

Breast biopsy, open, incisional

10-day global period ends

Oct 11, 2026

Covers Oct 1, 2026 through Oct 11, 2026 (11 days).

Visit on Oct 31, 2026

After the global period ends: visits and procedures are billed normally.

SurgeryVisit
Sep 28, 2026Oct 14, 2026

What modifiers do to the payment

Modifier 50 · payment effect

With and without the modifier

19101 without 50 · national office

$350.38

Breast biopsy, open, incisional

19101-50 · Bilateral: 150%

$525.57

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 19101

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

Codes related to 19101
CodeHow it relatesOffice range, Utah
Used instead
19100Breast biopsy, without imaging guidancePercutaneous breast biopsy without imaging guidance, rather than open incisional sampling.$155.59
19083Breast biopsy, first lesion, ultrasound-guidedPercutaneous breast biopsy with ultrasound guidance and localization-device placement when performed.$452.67
19120Breast lesion excision, without marker localizationUsed when the breast lesion is removed rather than sampled through an open incision.$548.30
19125Breast lesion excision, single marker-localized lesionBreast lesion excision with preoperative radiological localization, rather than incisional tissue sampling.$607.56
Often billed with
88305Tissue pathology exam, level IV specimenMay represent the separate surgical pathology examination of the breast biopsy specimen.$67.37

How 19101 has changed in Utah

19101 · Office / nonfacility

$334.56

Effective 2026-10-01

The base rate is $38.22 higher than on 2025-10-01, moving from $296.34 to $334.56 (12.9%).

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

    $296.34changed to$334.56

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 3.23 changed to 3.15
    • Practice expense RVU 5.56 changed to 6.55
    • Malpractice RVU 0.80 changed to 0.79
    • Practice expense GPCI 0.933 changed to 0.940
    • Malpractice GPCI 0.930 changed to 0.898

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $313.97changed to$296.34

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 5.86 changed to 5.56
    • Malpractice RVU 0.79 changed to 0.80

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $308.85changed to$313.97

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $318.11changed to$308.85

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 5.93 changed to 5.86
    • Malpractice RVU 0.77 changed to 0.79
    • Practice expense GPCI 0.926 changed to 0.933
    • Malpractice GPCI 0.865 changed to 0.930

  5. January 1, 2023

    RVU23A

    $323.89changed to$318.11

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 6.00 changed to 5.93
    • Practice expense GPCI 0.919 changed to 0.926
    • Malpractice GPCI 0.799 changed to 0.865

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $331.83changed to$323.89

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 6.19 changed to 6.00
    • Malpractice RVU 0.74 changed to 0.77

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $331.00changed to$331.83

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 5.65 changed to 6.19
    • Practice expense GPCI 0.923 changed to 0.919
    • Malpractice GPCI 0.982 changed to 0.799

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $336.81changed to$331.00

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 5.68 changed to 5.65
    • Malpractice RVU 0.73 changed to 0.74
    • Practice expense GPCI 0.927 changed to 0.923
    • Malpractice GPCI 1.165 changed to 0.982

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $339.78changed to$336.81

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 5.78 changed to 5.68

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $337.05changed to$339.78

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 5.74 changed to 5.78
    • Practice expense GPCI 0.925 changed to 0.927
    • Malpractice GPCI 1.167 changed to 1.165

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $336.11changed to$337.05

    • Conversion factor 35.8043 changed to 35.8887
    • Malpractice RVU 0.74 changed to 0.73
    • Practice expense GPCI 0.922 changed to 0.925
    • Malpractice GPCI 1.169 changed to 1.167

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $336.90changed to$336.11

    • Conversion factor 35.9335 changed to 35.8043
    • Malpractice RVU 0.73 changed to 0.74

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $335.22changed to$336.90

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $328.09changed to$335.22

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 5.66 changed to 5.74
    • Malpractice RVU 0.64 changed to 0.73
    • Practice expense GPCI 0.919 changed to 0.922
    • Malpractice GPCI 1.136 changed to 1.169

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $335.41changed to$328.09

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 6.43 changed to 5.66
    • Malpractice RVU 0.67 changed to 0.64
    • Practice expense GPCI 0.916 changed to 0.919
    • Malpractice GPCI 1.102 changed to 1.136

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $335.41

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$334.56$208.66RVU26D
2026-07-01$334.56$208.66RVU26C
2026-04-01$334.56$208.66RVU26B
2026-01-01$334.56$208.66RVU26A
2025-10-01$296.34$211.84RVU25D
2025-07-01$296.34$211.84RVU25C
2025-04-01$296.34$211.84RVU25B
2025-01-01$296.34$211.84RVU25A
2024-10-01$313.97$216.45RVU24D
2024-07-01$313.97$216.45RVU24C
2024-04-01$313.97$216.45RVU24B
2024-03-09$313.97$216.45RVU24AR
2024-01-01$308.85$212.92RVU24A
2023-10-01$318.11$217.06RVU23D
2023-07-01$318.11$217.06RVU23C
2023-04-01$318.11$217.06RVU23B
2023-01-01$318.11$217.06RVU23A
2022-10-01$323.89$218.30RVU22D
2022-07-01$323.89$218.30RVU22C
2022-04-01$323.89$218.30RVU22B
2022-01-01$323.89$218.30RVU22A
2021-10-01$331.83$217.67RVU21D
2021-07-01$331.83$217.67RVU21C
2021-04-01$331.83$217.67RVU21B
2021-01-01$331.83$217.67RVU21A
2020-10-01$331.00$225.41RVU20D
2020-07-01$331.00$225.41RVU20C
2020-04-01$331.00$225.41RVU20B
2020-01-01$331.00$225.41RVU20A
2019-10-01$336.81$228.24RVU19D
2019-07-01$336.81$228.24RVU19C
2019-04-01$336.81$228.24RVU19B
2019-01-01$336.81$228.24RVU19A
2018-10-01$339.78$227.32RVU18D
2018-07-01$339.78$227.32RVU18C
2018-04-01$339.78$227.32RVU18B
2018-01-01$339.78$227.32RVU18AR1
2017-10-01$337.05$226.17RVU17D
2017-07-01$337.05$226.17RVU17C
2017-04-01$337.05$226.17RVU17B
2017-01-01$337.05$226.17RVU17A
2016-10-01$336.11$225.85RVU16D
2016-07-01$336.11$225.85RVU16C
2016-04-01$336.11$225.85RVU16B
2016-01-01$336.11$225.85RVU16A
2015-10-01$336.90$226.57RVU15D
2015-07-01$336.90$226.57RVU15C
2015-04-01$335.22$225.45RVU15B
2015-01-01$335.22$225.45RVU15A
2014-10-01$328.09$220.10RVU14D
2014-07-01$328.09$220.10RVU14C
2014-04-01$328.09$220.10RVU14B
2014-01-01$328.09$220.10RVU14A
2013-10-01$335.41$217.91RVU13D
2013-07-01$335.41$217.91RVU13C
2013-04-01$335.41$217.91RVU13B
2013-01-01$335.41$217.91RVU13AR

Price 19101 for an earlier date of service

Where the Utah rate applies

Utah is a Medicare payment area, not a city. Our Census mapping connects it to 334 cities and communities in Utah. Some span more than one payment area; confirm with the service ZIP.

  • Alpine
  • Alta
  • Altamont
  • Alton
  • Amalga
  • American Fork
  • Aneth
  • Annabella

Browse all communities in Utah

19101 billing questions

When should 19101 be chosen over 19100?

Use 19101 for an open incisional sample obtained through a surgical incision. Code 19100 describes percutaneous breast sampling without imaging guidance.

How does 19101 differ from excision of a breast lesion?

19101 represents sampling of tissue through an incision. When the procedure removes the lesion rather than taking an incisional sample, consider an excision code such as 19120.

Can pathology be reported separately?

The tissue specimen may be examined and reported by a pathologist using an appropriate surgical pathology code, such as 88305, when the pathology service is performed.

How is bilateral breast biopsy reported?

CMS lists this as a bilateral procedure; modifier 50 is paid at 150%. The documentation should support open incisional biopsy on both sides.

Is an assistant surgeon payable for 19101?

No. CMS identifies a statutory restriction on assistant-at-surgery payment for this code. Co-surgeons and team surgery are also not permitted.

What postoperative care is included?

Related postoperative visits during the 10-day global period are included in the procedure.

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 19101PPRRVU2026_Oct_nonQPP.csv, line 1,666 (RVU26D)
Geographic factors for UtahGPCI2026.csv, line 104 (RVU26D)

Open CMS sourceHow we calculate rates

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