Billing code 19086: Breast biopsyMedicare rate & RVUs
Report this add-on for tissue sampling of an additional breast lesion using MRI guidance, alongside the primary MRI-guided breast biopsy code.
Medicare pays $553.12 for 19086 nationally in the office and $75.49 in a hospital or facility. Local office rates run $481.51–$772.83.
Medicare rate · 19086
Breast biopsy
Swap in your local Medicare rate.
- Work RVUs
- 1.77
- Total RVUs
- 16.56
- Global days
- ZZZ
National rate · 2026
$553.12
Office setting, before claim adjustments.
See every locality for 19086 → · Billed by an NP, PA or therapist? →
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 10 sections
What 19086 covers
This code covers needle sampling of an additional breast target identified and accessed with MRI guidance. It is typically performed by a radiologist or other qualified breast-imaging clinician in an outpatient imaging center or hospital MRI suite. The biopsy may include placement of a marker at the sampled site and imaging of the specimen when performed. The first MRI-guided lesion is reported separately with the primary code.
Report one unit for each additional lesion sampled under MRI guidance, supported by documentation identifying the targets and confirming MRI guidance and tissue sampling. Do not use this code by itself: it is an add-on reported with the primary MRI-guided breast biopsy procedure. Under the CMS rule for this code, payment is within the primary procedure’s global period. The documentation should distinguish each additional target from the first lesion and from targets sampled using another guidance method.
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 19086 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$481.51 to $772.83
109 of 109 payment localities
19086 rates by state
Office rate range in each state. Select a state to see its payment localities.
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Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$481.51
$685.60
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $611.87 | 1 |
| AL | $489.61 | 1 |
| AR | $481.51 | 1 |
| AZ | $537.16 | 1 |
| CA | $598.37–$772.83 | 29 |
| CO | $583.84 | 1 |
| CT | $593.09 | 1 |
| DC | $643.87 | 1 |
| DE | $546.98 | 1 |
| FL | $534.49–$581.82 | 3 |
| GA | $501.47–$562.25 | 2 |
| GU | $617.63 | 1 |
| HI | $617.63 | 1 |
| IA | $508.19 | 1 |
| ID | $511.06 | 1 |
| IL | $513.83–$571.10 | 4 |
| IN | $514.55 | 1 |
| KS | $503.42 | 1 |
| KY | $498.43 | 1 |
| LA | $496.72–$525.08 | 2 |
| MA | $578.79–$649.65 | 2 |
| MD | $559.10–$643.87 | 3 |
| ME | $511.91–$546.63 | 2 |
| MI | $511.37–$539.92 | 2 |
| MN | $563.28 | 1 |
| MO | $485.58–$529.69 | 3 |
| MS | $483.76 | 1 |
| MT | $553.11 | 1 |
| NC | $518.35 | 1 |
| ND | $549.75 | 1 |
| NE | $511.99 | 1 |
| NH | $572.43 | 1 |
| NJ | $600.96–$635.36 | 2 |
| NM | $513.73 | 1 |
| NV | $552.66 | 1 |
| NY | $527.02–$654.06 | 5 |
| OH | $510.68 | 1 |
| OK | $499.60 | 1 |
| OR | $549.48–$606.81 | 2 |
| PA | $512.76–$575.30 | 2 |
| PR | $558.41 | 1 |
| RI | $569.74 | 1 |
| SC | $515.15 | 1 |
| SD | $549.35 | 1 |
| TN | $506.05 | 1 |
| TX | $508.77–$580.91 | 8 |
| UT | $523.24 | 1 |
| VA | $543.15–$643.87 | 2 |
| VI | $558.41 | 1 |
| VT | $545.43 | 1 |
| WA | $578.41–$665.88 | 2 |
| WI | $528.68 | 1 |
| WV | $491.60 | 1 |
| WY | $551.64 | 1 |
How the 19086 rate is calculated
Each of 19086’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 · 19086
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.77Practice expense 14.62Malpractice 0.17
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 19086
The CMS indicators that decide how 19086 is paid alongside other services.
CMS payment indicators · 19086
Breast biopsy
| 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) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
19086 compared with similar codes
Compare codes
19086 vs 19085 vs 19084 vs 19082: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 19085Breast biopsy
- 19085 represents the first lesion sampled with MRI guidance and is the primary code. 19086 represents each additional MRI-guided lesion.
- 19084Breast biopsy
- Use 19084 for an additional lesion sampled with ultrasound guidance; use 19086 when MRI provides the guidance.
- 19082Breast biopsy
- 19082 is for an additional lesion sampled with stereotactic guidance. 19086 applies when the additional target is sampled under MRI guidance.
19086 billing questions
When is this code reported instead of 19085?
Use 19085 for the first lesion sampled with MRI guidance. Report 19086 for each additional lesion sampled with MRI guidance during the procedure.
Can 19086 be billed by itself?
No. It is an add-on code and must be reported with the primary MRI-guided breast biopsy code, 19085.
How many units should be reported?
Report one unit for each additional lesion sampled. The first lesion is represented by 19085, not by an additional unit of 19086.
Is marker placement separately reported?
Marker placement at the biopsy site, when performed, is part of the MRI-guided biopsy service. Specimen imaging, when performed, is also included in the service.
How does 19086 differ from 19084?
Both represent sampling of an additional lesion, but 19086 is for MRI guidance and 19084 is for ultrasound guidance.
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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