Billing code 19125: Breast lesion excisionMedicare rate & RVUs

Medicare pays $634.95 for 19125 nationally in the office and $452.58 in a hospital or facility. Local office rates run $556.83–$792.46.

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

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

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

109 of 109 payment localities

19125 rates by state

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

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.

Payment rules and modifiers for 19125

19125 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

19125 compared with similar codes

How to choose

19120Breast lesion excision

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 excision

19125 reports excision of the first marker-identified lesion; 19126 is the add-on for each additional lesion excised in the same session.

19101Breast biopsy

19101 is an open diagnostic biopsy involving tissue sampling. 19125 reports surgical excision of a lesion localized by a preoperative radiological marker.

Codes related to 19125

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