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Billing code 19126: Breast lesion excisionMedicare rate & RVUs

Reports open excision of each additional breast lesion identified by preoperative radiological marking, alongside the primary localized-lesion excision.

CMS RVU26DEffective Oct 1, 2026109 payment localities475 Medicare services in 2024

Medicare pays $143.96 for 19126 nationally in a facility.

Medicare rate · 19126

Breast lesion excision

Work RVUs
2.86
Total RVUs
4.31
Global days
ZZZ

National rate · 2026

$143.96

Facility setting, before claim adjustments.

See every locality for 19126 →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
  1. Medicare rate
  2. What 19126 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

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

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

109 of 109 payment localities

19126 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$130.37
Alaska*Unavailable$182.34
ArizonaUnavailable$139.70
ArkansasUnavailable$128.74
AtlantaUnavailable$149.53
AustinUnavailable$142.76
BakersfieldUnavailable$138.55
Baltimore/Surr. CntysUnavailable$153.02
BeaumontUnavailable$140.06
BrazoriaUnavailable$139.14

19126 rates by state

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

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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.

View every state and territory as a table
19126 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

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

RuleCMS valueWhat it means
Global periodZZZAdd-on code: falls within the primary procedure’s global period.
Multiple procedures0No multiple-procedure reduction.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)1Permitted with supporting documentation.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.

19126 compared with similar codes

Compare codes · National

4 codes, side by side

  • 19126

    Breast lesion excision2.86 wRVU

    Not priced

  • 19125

    Breast lesion excision6.52 wRVU

    $634.95

  • 19120

    Breast lesion excision5.77 wRVU

    $573.16

  • 19101

    Breast biopsy3.15 wRVU

    $350.38

How to choose

19125Breast lesion excision
19125 reports excision of the first breast lesion identified by preoperative radiological marking. Add 19126 for each additional separately localized lesion excised.
19120Breast lesion excision
19120 describes open breast-lesion excision without the specific radiological-marker localization structure used for 19125 and 19126.
19101Breast biopsy
19101 is an open breast biopsy, whereas 19126 represents excision of an additional lesion identified by preoperative radiological marking.

Codes related to 19126

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

Codes related to 19126
CodeHow it relatesNational office range
Add-on codes
19125Breast lesion excisionPrimary localized breast-lesion excision reported with 19126 for additional lesions.$556.83–$792.46
Used instead
19120Breast lesion excisionOpen breast-lesion excision when the specific preoperative radiological-marker coding structure is not used.$502.86–$718.63
Often billed with
19285Breast localizationBreast localization-device placement for one lesion may accompany the excision encounter.$306.72–$481.39
19286Breast localizationAdditional breast localization-device placement may accompany excision of multiple localized lesions.$249.05–$401.32

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

Show the CMS file lines behind this rate
RVUs for 19126PPRRVU2026_Oct_nonQPP.csv, line 1,672 (RVU26D)

Open CMS sourceHow we calculate rates

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