Billing code 19120: Breast lesion excisionMedicare rate & RVUs

Medicare pays $573.16 for 19120 nationally in the office and $407.82 in a hospital or facility. Local office rates run $502.86–$718.63.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 19120 covers

A surgeon removes breast tissue containing a cyst, fibroadenoma, or other lesion through an open incision. The specimen may include a palpable mass, abnormal duct tissue, aberrant breast tissue, or a nipple or areolar lesion. General or breast surgeons commonly perform the operation in an ambulatory surgery center or hospital operating room; selected cases may be done in an office procedure setting. This code covers one or more lesions when the operation is an excision, rather than needle sampling or removal of a lesion identified by a preoperative radiologic marker.

Choose 19120 based on the operative approach and target, not pathology findings alone. Document the breast and site, the lesion or lesions removed, and the open excision. The code has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For bilateral work, modifier 50 is paid at 150%. When multiple procedures occur in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Medicare does not pay an assistant at surgery for this service; co-surgeons and team surgery are 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 19120 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

19120 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 19120 rate is calculated

Each of 19120’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.

Payment rules and modifiers for 19120

19120 has a 90-day global period: related visits in that window are included in the surgery payment.

What modifiers do to the payment

When to use modifier 50

19120 compared with similar codes

How to choose

19100Breast biopsy

19100 is percutaneous tissue sampling without imaging guidance. Use 19120 when the surgeon removes the lesion through an open incision.

19101Breast biopsy

19101 describes open breast biopsy. Use 19120 when the operative service is excision of the lesion rather than diagnostic tissue sampling.

19125Breast lesion excision

19125 is for open excision of a lesion identified by preoperative placement of a radiologic marker; 19120 is for other qualifying open lesion excisions.

19126Breast lesion excision

19126 is an add-on for each additional marker-localized lesion removed with 19125. It is not an additional-lesion code for 19120.

Codes related to 19120

Related codes aren’t interchangeable: bill the code that matches the service performed.

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

Open CMS sourceHow we calculate rates