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CPT code 19125: Breast lesion excision, single marker-localized lesion2026 Medicare rate & RVUs in Delaware

Reports surgical excision of a single breast lesion identified by a preoperative radiological marker, commonly when the lesion is difficult to locate by touch.

CMS RVU26DEffective Oct 1, 2026One payment locality10.2K Medicare services in 2024

In Delaware, Medicare pays $626.04 for 19125 in the office and $445.86 when it’s performed in a hospital or facility.

$626.04Office (non-facility)
$445.86Hospital or facility
−1.4%vs the national office rate ($634.95)

Check a contract rate as a % of Medicare · 19125 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 19125 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Delaware
  2. What 19125 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 19125 covers

Code 19125 describes a surgeon’s removal of one breast lesion identified before surgery with a radiological marker, commonly a localization wire. It is typically used for a nonpalpable or difficult-to-localize target found on breast imaging. A radiologist or other qualified clinician may place the marker before the patient goes to the operating room; the surgeon then uses it to locate and excise the target. The code represents the excision, not the marker-placement service.

Select 19125 when the operative report documents excision of one marker-identified lesion. The record should support the target, its location, and the completed removal. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. In a same-session multiple-procedure claim, 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-surgeon payment requires supporting documentation, and team surgery is 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 Delaware compares for 19125

Across 109 of 109 payment localities, the office rate for 19125 runs from $556.83 in Arkansas to $792.46 in San Benito County, CA. Delaware pays $626.04. The RVUs are the same everywhere; the geographic indexes change the dollars.

19125 in Delaware vs other payment areas
  1. Delaware · this page$626.04
  2. Los Angeles, CA · California$691.10+$65.06
  3. Washington, DC area · District of Columbia$717.32+$91.28
  4. Miami, FL · Florida$735.55+$109.51
  5. Chicago, IL · Illinois$710.95+$84.91
  6. Manhattan, NY · New York$740.26+$114.22
  7. Alaska · Alaska$742.11+$116.07

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

Every other payment area

19125 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$565.46$405.89
ArkansasArkansas$556.83$400.17
ArizonaArizona$615.68$438.96
Bakersfield, CACalifornia$651.81$451.93
Chico, CACalifornia$647.28$447.40
El Centro, CACalifornia$647.56$447.68
Fresno, CACalifornia$647.28$447.40
Hanford, CACalifornia$647.28$447.40

19125 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.

$556.83

$742.11

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

View every state and territory as a table
19125 office rate range by state
State / territoryOffice rate rangeLocalities
AK$742.111
AL$565.461
AR$556.831
AZ$615.681
CA$647.28–$792.4629
CO$648.381
CT$678.891
DC$717.321
DE$626.041
FL$647.29–$735.553
GA$606.73–$652.662
GU$660.791
HI$660.791
IA$570.421
ID$576.491
IL$635.13–$710.954
IN$579.751
KS$572.461
KY$590.101
LA$591.07–$621.282
MA$646.18–$707.752
MD$636.86–$717.323
ME$584.86–$611.002
MI$610.78–$660.812
MN$605.921
MO$583.67–$617.733
MS$570.121
MT$634.841
NC$590.501
ND$601.621
NE$572.251
NH$642.741
NJ$682.32–$710.262
NM$616.261
NV$625.941
NY$600.23–$765.225
OH$603.991
OK$583.801
OR$616.84–$664.152
PA$602.26–$664.502
PR$638.081
RI$644.941
SC$599.091
SD$597.691
TN$576.111
TX$598.47–$655.268
UT$607.561
VA$612.32–$717.322
VI$638.081
VT$603.621
WA$643.51–$717.532
WI$580.961
WV$611.841
WY$620.361

See 19125 in every payment locality

How the 19125 rate is calculated

Each of 19125’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 · 19125

RVUs × geographic indexes × conversion factor

Office or facility?

Work6.52

6.52 RVUs× 1.000 GPCI

Practice expense10.81

10.81 RVUs× 1.000 GPCI

Malpractice1.68

1.68 RVUs× 1.000 GPCI

Adjusted RVUs

19.0100

Conversion factor

$33.4009

Medicare rate

$634.95

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

1,671

Code
19125
Physician work
6.52
Practice expense
10.81
Malpractice
1.68

GPCI2026.csv

40

Locality
Delaware
Physician work
1.005
Practice expense
0.988
Malpractice
0.899
Office calculation for 19125 in Delaware
ComponentRVULocality factorAdjusted
Physician work6.52× 1.0056.5526
Practice expense10.81× 0.98810.6803
Malpractice1.68× 0.8991.5103
Total RVUs18.7432
Conversion factor× 33.4009

Office rate, Delaware$626.04

Office: (6.52 × 1.005 + 10.81 × 0.988 + 1.68 × 0.899) × $33.4009 = $626.04

Facility: (6.52 × 1.005 + 5.35 × 0.988 + 1.68 × 0.899) × $33.4009 = $445.86

Open 19125 in the RVU calculator

Payment rules and modifiers for 19125

19125 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 19125

Breast lesion excision, single marker-localized lesion

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 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)1Permitted with supporting documentation.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.71/0.19Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 19125

Breast lesion excision, single marker-localized lesion

90-day global period ends

Dec 30, 2026

Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).

Visit on Oct 31, 2026

Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 50 · payment effect

With and without the modifier

19125 without 50 · national office

$634.95

Breast lesion excision, single marker-localized lesion

19125-50 · Bilateral: 150%

$952.43

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 19125

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

Codes related to 19125
CodeHow it relatesOffice range, Delaware
Add-on codes
19126Breast lesion excision, each additional lesionAdd-on code for each additional marker-localized breast lesion excised.No office rate
Often billed with
19285Breast localization, first lesion, ultrasound guidanceReports mammographic placement of a breast localization device for the first lesion.$346.58
Used instead
19120Breast lesion excision, without marker localizationOpen breast-lesion excision when preoperative marker identification is not the defining circumstance.$565.25
19101Breast biopsy, open, incisionalOpen biopsy for diagnostic tissue sampling rather than excision of the localized target.$345.61
19100Breast biopsy, without imaging guidancePercutaneous breast biopsy when tissue sampling, rather than surgical excision, is performed.$161.18

How 19125 has changed in Delaware

19125 · Office / nonfacility

$626.04

Effective 2026-10-01

The base rate is $66.39 higher than on 2025-10-01, moving from $559.65 to $626.04 (11.9%).

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

    $559.65changed to$626.04

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 6.69 changed to 6.52
    • Practice expense RVU 9.02 changed to 10.81
    • Malpractice RVU 1.69 changed to 1.68
    • 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

    $573.62changed to$559.65

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 8.95 changed to 9.02

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $564.26changed to$573.62

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $583.06changed to$564.26

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 8.85 changed to 8.95
    • Malpractice RVU 1.66 changed to 1.69
    • 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

    $596.81changed to$583.06

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 8.79 changed to 8.85
    • 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

    $592.97changed to$596.81

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 8.58 changed to 8.79
    • Malpractice RVU 1.62 changed to 1.66

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $587.90changed to$592.97

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 7.75 changed to 8.58
    • Malpractice RVU 1.61 changed to 1.62
    • 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

    $584.58changed to$587.90

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 7.55 changed to 7.75
    • Malpractice RVU 1.60 changed to 1.61
    • 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

    $578.03changed to$584.58

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 7.40 changed to 7.55
    • Malpractice RVU 1.59 changed to 1.60

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $575.36changed to$578.03

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 7.33 changed to 7.40
    • Malpractice RVU 1.60 changed to 1.59
    • 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

    $576.15changed to$575.36

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 7.35 changed to 7.33
    • Malpractice RVU 1.61 changed to 1.60
    • 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

    $577.45changed to$576.15

    • Conversion factor 35.9335 changed to 35.8043
    • Malpractice RVU 1.59 changed to 1.61

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $574.58changed to$577.45

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $557.86changed to$574.58

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 7.33 changed to 7.35
    • Malpractice RVU 1.36 changed to 1.59
    • 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

    $555.85changed to$557.86

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 8.25 changed to 7.33
    • Malpractice RVU 1.42 changed to 1.36
    • Practice expense GPCI 1.044 changed to 1.038
    • Malpractice GPCI 0.672 changed to 0.878

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $555.85

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$626.04$445.86RVU26D
2026-07-01$626.04$445.86RVU26C
2026-04-01$626.04$445.86RVU26B
2026-01-01$626.04$445.86RVU26A
2025-10-01$559.65$454.09RVU25D
2025-07-01$559.65$454.09RVU25C
2025-04-01$559.65$454.09RVU25B
2025-01-01$559.65$454.09RVU25A
2024-10-01$573.62$463.66RVU24D
2024-07-01$573.62$463.66RVU24C
2024-04-01$573.62$463.66RVU24B
2024-03-09$573.62$463.66RVU24AR
2024-01-01$564.26$456.10RVU24A
2023-10-01$583.06$469.42RVU23D
2023-07-01$583.06$469.42RVU23C
2023-04-01$583.06$469.42RVU23B
2023-01-01$583.06$469.42RVU23A
2022-10-01$596.81$478.33RVU22D
2022-07-01$596.81$478.33RVU22C
2022-04-01$596.81$478.33RVU22B
2022-01-01$596.81$478.33RVU22A
2021-10-01$592.97$476.36RVU21D
2021-07-01$592.97$476.36RVU21C
2021-04-01$592.97$476.36RVU21B
2021-01-01$592.97$476.36RVU21A
2020-10-01$587.90$487.67RVU20D
2020-07-01$587.90$487.67RVU20C
2020-04-01$587.90$487.67RVU20B
2020-01-01$587.90$487.67RVU20A
2019-10-01$584.58$488.73RVU19D
2019-07-01$584.58$488.73RVU19C
2019-04-01$584.58$488.73RVU19B
2019-01-01$584.58$488.73RVU19A
2018-10-01$578.03$487.06RVU18D
2018-07-01$578.03$487.06RVU18C
2018-04-01$578.03$487.06RVU18B
2018-01-01$578.03$487.06RVU18AR1
2017-10-01$575.36$485.97RVU17D
2017-07-01$575.36$485.97RVU17C
2017-04-01$575.36$485.97RVU17B
2017-01-01$575.36$485.97RVU17A
2016-10-01$576.15$486.45RVU16D
2016-07-01$576.15$486.45RVU16C
2016-04-01$576.15$486.45RVU16B
2016-01-01$576.15$486.45RVU16A
2015-10-01$577.45$486.32RVU15D
2015-07-01$577.45$486.32RVU15C
2015-04-01$574.58$483.90RVU15B
2015-01-01$574.58$483.90RVU15A
2014-10-01$557.86$468.25RVU14D
2014-07-01$557.86$468.25RVU14C
2014-04-01$557.86$468.25RVU14B
2014-01-01$557.86$468.25RVU14A
2013-10-01$555.85$457.82RVU13D
2013-07-01$555.85$457.82RVU13C
2013-04-01$555.85$457.82RVU13B
2013-01-01$555.85$457.82RVU13AR

Price 19125 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

19125 billing questions

How is 19125 different from 19120?

19125 is for excision of a lesion identified by a preoperative radiological marker. 19120 is the open excision code when that marker-based identification is not the defining circumstance.

Can 19125 be reported for more than one lesion?

19125 describes one marker-identified lesion. For an additional lesion, report 19126 when its requirements are met.

Is placement of the breast localization device included?

The marker-placement service is separate from the excision. When performed and documented, the appropriate localization-placement code may be reported by the clinician performing that service.

What documentation supports 19125?

The operative report should establish that the excised lesion was identified by a preoperative radiological marker and document the target and its location.

How does Medicare handle bilateral 19125?

When the procedure is performed bilaterally and reported with modifier 50, CMS pays the bilateral procedure at 150%.

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 19125PPRRVU2026_Oct_nonQPP.csv, line 1,671 (RVU26D)
Geographic factors for DelawareGPCI2026.csv, line 40 (RVU26D)

Open CMS sourceHow we calculate rates

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