CPT code 19126: Breast lesion excision, each additional lesion2026 Medicare rate & RVUs in Maryland
Reports open excision of each additional breast lesion identified by preoperative radiological marking, alongside the primary localized-lesion excision.
CMS doesn’t publish an office rate for 19126 in Maryland.
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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What 19126 covers
This add-on represents open removal of an additional breast lesion that was identified by preoperative radiological marking. A breast surgeon or other operating surgeon excises the separately localized lesion, often during the same operation as removal of the first localized lesion. It is suited to cases with more than one distinct lesion selected for excision, including nonpalpable findings localized before surgery.
Report 19126 with 19125 for each additional localized lesion beyond the first; do not report it by itself. The operative record should support the separate lesion excised and its preoperative radiological localization. CMS treats this as an add-on code billed with a primary procedure, with payment within that procedure’s global period.
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 19126 pays more and less in Maryland
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Baltimore area, MD | Unavailable | $153.02 |
| Rest of Maryland | Unavailable | $143.20 |
| Washington, DC area | Unavailable | $156.15 |
How the 19126 rate is calculated
Each of 19126’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 · 19126
RVUs × geographic indexes × conversion factor
Work2.86
2.86 RVUs× 1.000 GPCI
Practice expense0.72
0.72 RVUs× 1.000 GPCI
Malpractice0.73
0.73 RVUs× 1.000 GPCI
Adjusted RVUs
4.3100
Conversion factor
$33.4009
Medicare rate
$143.96
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 19126
The CMS indicators that decide how 19126 is paid alongside other services.
CMS payment indicators · 19126
Breast lesion excision, each additional lesion
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| 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. |
19126 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 19125Breast lesion excisionSingle marker-localized lesion
- 19125 reports excision of the first breast lesion identified by preoperative radiological marking. Add 19126 for each additional separately localized lesion excised.
- 19120Breast lesion excisionWithout marker localization
- 19120 describes open breast-lesion excision without the specific radiological-marker localization structure used for 19125 and 19126.
- 19101Breast biopsyOpen, incisional
- 19101 is an open breast biopsy, whereas 19126 represents excision of an additional lesion identified by preoperative radiological marking.
19126 billing questions
When should 19126 be reported instead of 19125?
Use 19125 for the first breast lesion identified by preoperative radiological marking and 19126 for each additional separately localized lesion excised during the operation.
Can 19126 be billed by itself?
No. It is an add-on code reported with 19125, the primary localized-lesion excision.
What documentation supports an additional unit?
The operative record should establish that another distinct lesion was excised and that it had been identified by preoperative radiological marking.
How is 19126 paid under the CMS rule?
CMS identifies it as an add-on billed with a primary procedure, with payment within that procedure’s global period.
How does 19126 differ from 19120?
19126 is for an additional lesion identified by preoperative radiological marking and accompanies 19125. 19120 describes breast lesion excision without that specific localization-code structure.
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
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