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

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 Puerto Rico, Medicare pays $638.08 for 19125 in the office and $453.71 when it’s performed in a hospital or facility.

$638.08Office (non-facility)
$453.71Hospital or facility
+0.5%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 Puerto Rico
  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 Puerto Rico 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. Puerto Rico pays $638.08. The RVUs are the same everywhere; the geographic indexes change the dollars.

19125 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$638.08
  2. Los Angeles, CA · California$691.10+$53.02
  3. Washington, DC area · District of Columbia$717.32+$79.24
  4. Miami, FL · Florida$735.55+$97.47
  5. Chicago, IL · Illinois$710.95+$72.87
  6. Manhattan, NY · New York$740.26+$102.18
  7. Alaska · Alaska$742.11+$104.03

Other areas in Puerto Rico 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 Puerto Rico 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

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 19125 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work6.52× 1.0006.5200
Practice expense10.81× 1.01110.9289
Malpractice1.68× 0.9851.6548
Total RVUs19.1037
Conversion factor× 33.4009

Office rate, Puerto Rico$638.08

Office: (6.52 × 1 + 10.81 × 1.011 + 1.68 × 0.985) × $33.4009 = $638.08

Facility: (6.52 × 1 + 5.35 × 1.011 + 1.68 × 0.985) × $33.4009 = $453.71

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, Puerto Rico
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.$353.46
Used instead
19120Breast lesion excision, without marker localizationOpen breast-lesion excision when preoperative marker identification is not the defining circumstance.$576.09
19101Breast biopsy, open, incisionalOpen biopsy for diagnostic tissue sampling rather than excision of the localized target.$352.39
19100Breast biopsy, without imaging guidancePercutaneous breast biopsy when tissue sampling, rather than surgical excision, is performed.$164.41

How 19125 has changed in Puerto Rico

19125 · Office / nonfacility

$638.08

Effective 2026-10-01

The base rate is $74.19 higher than on 2025-10-01, moving from $563.89 to $638.08 (13.2%).

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

    $563.89changed to$638.08

    • 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
    • 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

    $577.95changed to$563.89

    • 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

    $568.51changed to$577.95

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $584.36changed to$568.51

    • 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
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $582.86changed to$584.36

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

  6. January 1, 2023

    RVU23A

    $594.78changed to$582.86

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

    $590.95changed to$594.78

    • 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.

  8. January 1, 2021

    RVU21A

    $580.78changed to$590.95

    • 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
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $572.19changed to$580.78

    • 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
    • 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

    $565.77changed to$572.19

    • 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.

  11. January 1, 2018

    RVU18AR1

    $502.14changed to$565.77

    • 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
    • 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

    $441.95changed to$502.14

    • 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
    • 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

    $443.33changed to$441.95

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

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $441.13changed to$443.33

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $434.56changed to$441.13

    • 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 0.692 changed to 0.705
    • Malpractice GPCI 0.271 changed to 0.293

    Held through RVU15B.

  16. January 1, 2014

    RVU14A

    $429.95changed to$434.56

    • 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 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: $429.95

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$638.08$453.71RVU26D
2026-07-01$638.08$453.71RVU26C
2026-04-01$638.08$453.71RVU26B
2026-01-01$638.08$453.71RVU26A
2025-10-01$563.89$456.72RVU25D
2025-07-01$563.89$456.72RVU25C
2025-04-01$563.89$456.72RVU25B
2025-01-01$563.89$456.72RVU25A
2024-10-01$577.95$466.32RVU24D
2024-07-01$577.95$466.32RVU24C
2024-04-01$577.95$466.32RVU24B
2024-03-09$577.95$466.32RVU24AR
2024-01-01$568.51$458.71RVU24A
2023-10-01$584.36$470.61RVU23D
2023-07-01$582.86$470.02RVU23C
2023-04-01$582.86$470.02RVU23B
2023-01-01$582.86$470.02RVU23A
2022-10-01$594.78$477.92RVU22D
2022-07-01$594.78$477.92RVU22C
2022-04-01$594.78$477.92RVU22B
2022-01-01$594.78$477.92RVU22A
2021-10-01$590.95$475.93RVU21D
2021-07-01$590.95$475.93RVU21C
2021-04-01$590.95$475.93RVU21B
2021-01-01$590.95$475.93RVU21A
2020-10-01$580.78$481.83RVU20D
2020-07-01$580.78$481.83RVU20C
2020-04-01$580.78$481.83RVU20B
2020-01-01$580.78$481.83RVU20A
2019-10-01$572.19$477.47RVU19D
2019-07-01$572.19$477.47RVU19C
2019-04-01$572.19$477.47RVU19B
2019-01-01$572.19$477.47RVU19A
2018-10-01$565.77$475.86RVU18D
2018-07-01$565.77$475.86RVU18C
2018-04-01$565.77$475.86RVU18B
2018-01-01$565.77$475.86RVU18AR1
2017-10-01$502.14$427.49RVU17D
2017-07-01$502.14$427.49RVU17C
2017-04-01$502.14$427.49RVU17B
2017-01-01$502.14$427.49RVU17A
2016-10-01$441.95$380.61RVU16D
2016-07-01$441.95$380.61RVU16C
2016-04-01$441.95$380.61RVU16B
2016-01-01$441.95$380.61RVU16A
2015-10-01$443.33$381.01RVU15D
2015-07-01$443.33$381.01RVU15C
2015-04-01$441.13$379.12RVU15B
2015-01-01$441.13$379.12RVU15A
2014-10-01$434.56$374.82RVU14D
2014-07-01$434.56$374.82RVU14C
2014-04-01$434.56$374.82RVU14B
2014-01-01$434.56$374.82RVU14A
2013-10-01$429.95$366.28RVU13D
2013-07-01$429.95$366.28RVU13C
2013-04-01$429.95$366.28RVU13B
2013-01-01$429.95$366.28RVU13AR

Price 19125 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

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 Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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