CPT code 19125: Breast lesion excision, single marker-localized lesion2026 Medicare rate & RVUs in Texas
Reports surgical excision of a single breast lesion identified by a preoperative radiological marker, commonly when the lesion is difficult to locate by touch.
Medicare pays $598.47–$655.26 for 19125 in the office in Texas, from Beaumont, TX to Houston, 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 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.
Where 19125 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
$598.47 to $655.26
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin, TX | $649.93 | $456.99 |
| Beaumont, TX | $598.47 | $432.52 |
| Brazoria, TX | $621.10 | $440.37 |
| Dallas, TX | $627.50 | $445.86 |
| Fort Worth, TX | $624.62 | $444.80 |
| Galveston, TX | $624.51 | $443.42 |
| Houston, TX | $655.26 | $474.17 |
| Rest of Texas | $611.09 | $438.03 |
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
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.
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
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are 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) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.71/0.19 | Share 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.
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).
19125 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 19120Breast lesion excisionWithout marker localization
- Use 19125 when the single excised lesion was identified by a preoperative radiological marker. Use 19120 for open lesion excision when that marker-based identification does not define the service.
- 19126Breast lesion excisionEach additional lesion
- 19125 reports excision of the first marker-identified lesion; 19126 is the add-on for each additional lesion excised in the same session.
- 19101Breast biopsyOpen, incisional
- 19101 is an open diagnostic biopsy involving tissue sampling. 19125 reports surgical excision of a lesion localized by a preoperative radiological marker.
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
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