$142.69–$212.69
19100 describes percutaneous breast sampling without imaging guidance. Choose 19101 when the surgeon obtains the sample through an incision.
On this page
CMS RVU26D · Effective 2026-10-01
19101 Breast biopsy Medicare reimbursement rates
Reports surgical sampling of breast tissue through an incision when an open incisional biopsy is performed rather than percutaneous sampling or lesion removal. Compare 19101 office and facility rates across CMS payment localities.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 19101?
The service location and office or facility setting determine which base rate applies. These are the supported base rates for the 109 payment areas shown below, using the same CMS release.
Office / nonfacility
$306.73–$446.40
109 of 109 localities have a supported rate.
Lowest: Arkansas
Highest: San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
A spread of $139.67 per service.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Where 19101 pays more and less
109 payment localities
$306.73 to $446.40
Breast surgery
About 19101: Open incisional breast biopsy
Reports surgical sampling of breast tissue through an incision when an open incisional biopsy is performed rather than percutaneous sampling or lesion removal.
A surgeon makes an incision in the breast and removes a tissue sample for diagnostic examination. This approach may be selected when a breast mass or other suspicious area needs tissue diagnosis and an open sample is performed instead of a percutaneous biopsy. The service is commonly performed by a breast surgeon or general surgeon in an operating room or other surgical setting, with the specimen sent for pathology examination.
Report this code for open incisional sampling, not when the procedure removes the breast lesion as a whole. The operative note should identify the breast and site, describe the open sampling approach, and document the tissue obtained. Related postoperative visits during the 10-day global period are included. For multiple procedures in one session, Medicare pays the highest-valued procedure in full and other procedures at 50%. For bilateral reporting with modifier 50, payment is 150%. Medicare does not pay an assistant at surgery for this service; co-surgeons and team surgery are not permitted.
CMS billing rules for 19101
- Global period
- Minor procedure with a 10-day global period: related postoperative visits for 10 days are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral procedure with modifier 50 is paid at 150%.
- Assistant at surgery
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU3.15 · 30%
- Practice expense (office) RVU6.55 · 62%
- Malpractice RVU0.79 · 8%
751
Medicare services in 2024 · #3208 by national volume
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.
19101 compared with similar codes
Office rate ranges across all CMS payment localities, from the same CMS release.
$418.88–$642.08
19083 is a percutaneous biopsy performed with ultrasound guidance and includes localization-device placement when performed; 19101 is an open incisional biopsy.
$502.86–$718.63
19120 is for removal of a breast lesion. Use 19101 when the operative service is incisional sampling rather than removal of the lesion.
$556.83–$792.46
19125 describes excision of a breast lesion identified by preoperative radiological localization. It is not the open incisional sampling represented by 19101.
See how rates vary across the country
19101 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.
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.
$306.73
$405.35
Color shows the midpoint of each state’s locality range.
View all state and territory rates as a table
| State / territory | Rate range | Localities |
|---|---|---|
| AK | $405.35 | 1 |
| AL | $311.58 | 1 |
| AR | $306.73 | 1 |
| AZ | $339.79 | 1 |
| CA | $360.92–$446.40 | 29 |
| CO | $359.86 | 1 |
| CT | $374.87 | 1 |
| DC | $397.98 | 1 |
| DE | $345.61 | 1 |
| FL | $354.02–$399.69 | 3 |
| GA | $331.81–$359.50 | 2 |
| GU | $369.24 | 1 |
| HI | $369.24 | 1 |
| IA | $315.87 | 1 |
| ID | $318.97 | 1 |
| IL | $346.20–$386.38 | 4 |
| IN | $320.84 | 1 |
| KS | $316.29 | 1 |
| KY | $323.85 | 1 |
| LA | $324.11–$341.06 | 2 |
| MA | $358.30–$394.23 | 2 |
| MD | $351.89–$397.98 | 3 |
| ME | $322.90–$338.67 | 2 |
| MI | $334.75–$360.82 | 2 |
| MN | $338.14 | 1 |
| MO | $319.50–$339.93 | 3 |
| MS | $313.08 | 1 |
| MT | $350.32 | 1 |
| NC | $326.19 | 1 |
| ND | $334.70 | 1 |
| NE | $317.12 | 1 |
| NH | $356.05 | 1 |
| NJ | $377.27–$393.80 | 2 |
| NM | $337.52 | 1 |
| NV | $346.19 | 1 |
| NY | $331.60–$421.07 | 5 |
| OH | $331.55 | 1 |
| OK | $321.08 | 1 |
| OR | $341.66–$369.59 | 2 |
| PA | $330.98–$366.33 | 2 |
| PR | $352.39 | 1 |
| RI | $356.74 | 1 |
| SC | $329.79 | 1 |
| SD | $332.85 | 1 |
| TN | $318.25 | 1 |
| TX | $328.81–$360.27 | 8 |
| UT | $334.56 | 1 |
| VA | $338.90–$397.98 | 2 |
| VI | $352.39 | 1 |
| VT | $335.15 | 1 |
| WA | $357.03–$400.47 | 2 |
| WI | $322.93 | 1 |
| WV | $333.09 | 1 |
| WY | $343.51 | 1 |
Compare 19101 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | Office $311.58 | Facility $194.38 |
| Alaska* | Office $405.35 | Facility $262.71 |
| Arizona | Office $339.79 | Facility $210.01 |
| Arkansas | Office $306.73 | Facility $191.68 |
| Atlanta | Office $359.50 | Facility $223.41 |
| Austin | Office $360.27 | Facility $218.56 |
| Bakersfield | Office $363.06 | Facility $216.26 |
| Baltimore/Surr. Cntys | Office $374.28 | Facility $230.57 |
| Beaumont | Office $328.81 | Facility $206.93 |
| Brazoria | Office $343.44 | Facility $210.71 |
| Chicago | Office $386.38 | Facility $251.77 |
| Chico | Office $360.92 | Facility $214.13 |
| Colorado | Office $359.86 | Facility $217.35 |
| Connecticut | Office $374.87 | Facility $230.62 |
| Dallas | Office $346.70 | Facility $213.30 |
| Dc + Md/Va Suburbs | Office $397.98 | Facility $240.20 |
| Delaware | Office $345.61 | Facility $213.28 |
| Detroit | Office $360.82 | Facility $231.57 |
| East St. Louis | Office $359.63 | Facility $236.41 |
| El Centro | Office $361.06 | Facility $214.26 |
| Fort Lauderdale | Office $374.54 | Facility $238.86 |
| Fort Worth | Office $344.86 | Facility $212.79 |
| Fresno | Office $360.92 | Facility $214.13 |
| Galveston | Office $345.15 | Facility $212.15 |
| Hanford-Corcoran | Office $360.92 | Facility $214.13 |
| Hawaii, Guam | Office $369.24 | Facility $216.95 |
| Houston | Office $359.61 | Facility $226.61 |
| Idaho | Office $318.97 | Facility $195.74 |
| Indiana | Office $320.84 | Facility $196.68 |
| Iowa | Office $315.87 | Facility $193.32 |
| Kansas | Office $316.29 | Facility $195.21 |
| Kentucky | Office $323.85 | Facility $204.78 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | Office $385.86 | Facility $227.41 |
| Madera | Office $360.92 | Facility $214.13 |
| Manhattan | Office $408.01 | Facility $252.38 |
| Merced | Office $360.92 | Facility $214.13 |
| Metropolitan Boston | Office $394.23 | Facility $234.31 |
| Metropolitan Kansas City | Office $336.42 | Facility $210.66 |
| Metropolitan Philadelphia | Office $366.33 | Facility $226.90 |
| Metropolitan St. Louis | Office $339.93 | Facility $212.42 |
| Miami | Office $399.69 | Facility $260.26 |
| Minnesota | Office $338.14 | Facility $200.32 |
| Mississippi | Office $313.08 | Facility $197.76 |
| Modesto | Office $360.92 | Facility $214.13 |
| Montana** | Office $350.32 | Facility $216.39 |
| Napa | Office $413.59 | Facility $237.06 |
| Nebraska | Office $317.12 | Facility $193.49 |
| Nevada** | Office $346.19 | Facility $212.12 |
| New Hampshire | Office $356.05 | Facility $216.62 |
| New Mexico | Office $337.52 | Facility $214.70 |
| New Orleans | Office $341.06 | Facility $215.02 |
| North Carolina | Office $326.19 | Facility $201.23 |
| North Dakota** | Office $334.70 | Facility $200.76 |
| Northern Nj | Office $393.80 | Facility $238.43 |
| Nyc Suburbs/Long Island | Office $421.07 | Facility $261.82 |
| Ohio | Office $331.55 | Facility $209.27 |
| Oklahoma | Office $321.08 | Facility $201.48 |
| Oxnard-Thousand Oaks-Ventura | Office $383.19 | Facility $224.88 |
| Portland | Office $369.59 | Facility $220.78 |
| Poughkpsie/N Nyc Suburbs | Office $381.43 | Facility $234.77 |
| Puerto Rico | Office $352.39 | Facility $216.98 |
| Queens | Office $408.59 | Facility $250.27 |
| Redding | Office $360.92 | Facility $214.13 |
| Rest Of California | Office $360.92 | Facility $214.13 |
| Rest Of Florida | Office $354.02 | Facility $225.98 |
| Rest Of Georgia | Office $331.81 | Facility $212.34 |
| Rest Of Illinois | Office $346.20 | Facility $223.91 |
| Rest Of Louisiana | Office $324.11 | Facility $205.57 |
| Rest Of Maine | Office $322.90 | Facility $199.68 |
| Rest Of Maryland | Office $351.89 | Facility $216.34 |
| Rest Of Massachusetts | Office $358.30 | Facility $217.26 |
| Rest Of Michigan | Office $334.75 | Facility $212.46 |
| Rest Of Missouri | Office $319.50 | Facility $204.04 |
| Rest Of New Jersey | Office $377.27 | Facility $231.01 |
| Rest Of New York | Office $331.60 | Facility $204.36 |
| Rest Of Oregon | Office $341.66 | Facility $208.26 |
| Rest Of Pennsylvania | Office $330.98 | Facility $208.03 |
| Rest Of Texas | Office $336.66 | Facility $209.55 |
| Rest Of Washington | Office $357.03 | Facility $216.00 |
| Rhode Island | Office $356.74 | Facility $218.39 |
| Riverside-San Bernardino-Ontario | Office $369.39 | Facility $222.60 |
| Sacramento-Roseville-Folsom | Office $377.58 | Facility $221.81 |
| Salinas | Office $376.18 | Facility $220.95 |
| San Diego-Chula Vista-Carlsbad | Office $384.33 | Facility $224.14 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | Office $435.79 | Facility $246.94 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | Office $434.90 | Facility $246.04 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | Office $446.40 | Facility $253.27 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | Office $442.74 | Facility $249.60 |
| San Luis Obispo-Paso Robles | Office $370.33 | Facility $217.78 |
| Santa Cruz-Watsonville | Office $387.38 | Facility $224.64 |
| Santa Maria-Santa Barbara | Office $377.39 | Facility $221.22 |
| Santa Rosa-Petaluma | Office $391.17 | Facility $226.69 |
| Seattle (King Cnty) | Office $400.47 | Facility $236.13 |
| South Carolina | Office $329.79 | Facility $206.03 |
| South Dakota** | Office $332.85 | Facility $198.92 |
| Southern Maine | Office $338.67 | Facility $205.94 |
| Stockton | Office $360.92 | Facility $214.13 |
| Suburban Chicago | Office $377.39 | Facility $239.84 |
| Tennessee | Office $318.25 | Facility $196.50 |
| Utah | Office $334.56 | Facility $208.66 |
| Vallejo | Office $412.30 | Facility $235.77 |
| Vermont | Office $335.15 | Facility $202.55 |
| Virgin Islands | Office $352.39 | Facility $216.98 |
| Virginia | Office $338.90 | Facility $207.24 |
| Visalia | Office $360.92 | Facility $214.13 |
| West Virginia | Office $333.09 | Facility $216.70 |
| Wisconsin | Office $322.93 | Facility $194.62 |
| Wyoming** | Office $343.51 | Facility $209.58 |
| Yuba City | Office $360.92 | Facility $214.13 |
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19101 billing questions
When should 19101 be chosen over 19100?
Use 19101 for an open incisional sample obtained through a surgical incision. Code 19100 describes percutaneous breast sampling without imaging guidance.
How does 19101 differ from excision of a breast lesion?
19101 represents sampling of tissue through an incision. When the procedure removes the lesion rather than taking an incisional sample, consider an excision code such as 19120.
Can pathology be reported separately?
The tissue specimen may be examined and reported by a pathologist using an appropriate surgical pathology code, such as 88305, when the pathology service is performed.
How is bilateral breast biopsy reported?
CMS lists this as a bilateral procedure; modifier 50 is paid at 150%. The documentation should support open incisional biopsy on both sides.
Is an assistant surgeon payable for 19101?
No. CMS identifies a statutory restriction on assistant-at-surgery payment for this code. Co-surgeons and team surgery are also not permitted.
What postoperative care is included?
Related postoperative visits during the 10-day global period are included in the procedure.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
1,66319085,,Bx breast 1st lesion mr imag,A,,3.55,17.62,,0.63,,0.35,21.52,4.53,0,000,0.00,0.00,0.00,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,66419086,,Bx breast add lesion mr imag,A,,1.77,14.62,,0.32,,0.17,16.56,2.26,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,66519100,,Bx breast percut w/o image,A,,1.24,3.35,,0.31,,0.30,4.89,1.85,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,66619101,,Biopsy of breast open,A,,3.15,6.55,,2.54,,0.79,10.49,6.48,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,66719105,,Cryosurg ablate fa each,A,,3.60,71.34,,1.22,,0.98,75.92,5.80,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,66819110,,Nipple exploration,A,,4.33,10.54,,5.19,,1.13,16.00,10.65,0,090,0.10,0.71,0.19,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,66919112,,Excise breast duct fistula,A,,3.71,10.42,,5.19,,1.01,15.14,9.91,0,090,0.10,0.71,0.19,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00