FeeBase
Log inGet started
Menu
On this page

CMS RVU26D · Effective 2026-10-01

19112 in Austin

Office / nonfacility

$522.28

Base rate per service

Facility setting

$337.46

Base rate per service

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.

Breast surgery

About 19112: Breast duct fistula excision

Reports surgical removal of a breast duct fistula, typically for persistent drainage from a fistulous tract involving the nipple or areola.

A surgeon excises a fistulous tract involving a breast duct, commonly to treat persistent drainage near the nipple or areola. The procedure is generally performed in an operating room and is distinct from sampling a breast mass or exploring the nipple without excising a duct fistula. The operative report should establish that the target is a duct fistula and describe its location and excision.

Report this code for definitive excision of the fistula, rather than for a diagnostic breast biopsy or removal of a separate breast lesion. It has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard reduction. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.

CMS billing rules for 19112

Global period
Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care 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
Assistant at surgery is paid only with documentation of medical necessity.
Co-surgeons
Co-surgeons not permitted.
Team surgery
Team surgery not permitted.

Where the value comes from

  • Work RVU3.71 · 25%
  • Practice expense (office) RVU10.42 · 69%
  • Malpractice RVU1.01 · 7%

21

Medicare services in 2024 · #5884 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.

19112 compared with similar codes

Office rates for Austin, from the same CMS release.

19110

Nipple exploration

With or without duct excision

$550.82

Use 19112 when a breast duct fistula is excised. Nipple exploration is a different procedure when no duct fistula excision is performed.

19120

Breast lesion excision

Without marker localization

$587.28

Use 19120 for excision of a breast lesion; use 19112 when the surgical target is a duct fistula.

19101

Breast biopsy

Open, incisional

$360.27

19101 is an open breast biopsy for diagnostic tissue sampling. 19112 is therapeutic excision of a duct fistula.

19100

Breast biopsy

Without imaging guidance

$168.76

19100 describes percutaneous breast biopsy. It is not the code for surgical removal of a duct fistula.

The same code, a different location

How does Austin compare?

In Beaumont, the office rate for 19112 is $471.97—$50.31 lower than the $522.28 rate in Austin. Both use the same code, release and participation basis.

19112 across payment areas

Same release and payment basis · bars start at $0

  1. Austin · This locality

    $522.28

  2. Beaumont

    $471.97

    $50.31 lower than Austin

  3. Brazoria

    $496.13

    $26.15 lower than Austin

  4. Dallas

    $500.62

    $21.66 lower than Austin

  5. Fort Worth

    $497.58

    $24.70 lower than Austin

  6. Galveston

    $498.44

    $23.84 lower than Austin

  7. Houston

    $516.93

    $5.35 lower than Austin

Other payment areas listed in Texas appear first, followed by selected cross-country examples. The chart compares amounts, not distance.

Across 109 of 109 CMS payment localities with a supported office rate, 19112 ranges from $440.25 in Arkansas to $657.50 in San Jose-Sunnyvale-Santa Clara (San Benito Cnty). This is a geographic range, not an average.

The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.

Compare all 108 other payment areas

  • Rest Of Texas

    Texas · 19112

    Office

    $484.67

    Facility

    $318.89

    $37.61 lower than Austin for the office setting.

  • Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty)

    California · 19112

    Office

    $563.13

    Facility

    $356.47

    $40.85 higher than Austin for the office setting.

  • Dc + Md/Va Suburbs

    District of Columbia · 19112

    Office

    $578.14

    Facility

    $372.36

    $55.86 higher than Austin for the office setting.

  • Miami

    Florida · 19112

    Office

    $571.54

    Facility

    $389.69

    $49.26 higher than Austin for the office setting.

  • Chicago

    Illinois · 19112

    Office

    $551.98

    Facility

    $376.42

    $29.70 higher than Austin for the office setting.

  • Manhattan

    New York · 19112

    Office

    $589.77

    Facility

    $386.79

    $67.49 higher than Austin for the office setting.

  • Alaska*

    Alaska · 19112

    Office

    $575.12

    Facility

    $389.08

    $52.84 higher than Austin for the office setting.

  • Alabama

    Alabama · 19112

    Office

    $447.54

    Facility

    $294.69

    $74.74 lower than Austin for the office setting.

  • Arkansas

    Arkansas · 19112

    Office

    $440.25

    Facility

    $290.20

    $82.03 lower than Austin for the office setting.

  • Arizona

    Arizona · 19112

    Office

    $490.04

    Facility

    $320.77

    $32.24 lower than Austin for the office setting.

  • Bakersfield

    California · 19112

    Office

    $528.27

    Facility

    $336.81

    $5.99 higher than Austin for the office setting.

  • Chico

    California · 19112

    Office

    $525.55

    Facility

    $334.10

    $3.27 higher than Austin for the office setting.

  • El Centro

    California · 19112

    Office

    $525.72

    Facility

    $334.27

    $3.44 higher than Austin for the office setting.

  • Fresno

    California · 19112

    Office

    $525.55

    Facility

    $334.10

    $3.27 higher than Austin for the office setting.

  • Hanford-Corcoran

    California · 19112

    Office

    $525.55

    Facility

    $334.10

    $3.27 higher than Austin for the office setting.

  • Madera

    California · 19112

    Office

    $525.55

    Facility

    $334.10

    $3.27 higher than Austin for the office setting.

  • Merced

    California · 19112

    Office

    $525.55

    Facility

    $334.10

    $3.27 higher than Austin for the office setting.

  • Modesto

    California · 19112

    Office

    $525.55

    Facility

    $334.10

    $3.27 higher than Austin for the office setting.

  • Napa

    California · 19112

    Office

    $607.57

    Facility

    $377.34

    $85.29 higher than Austin for the office setting.

  • Oxnard-Thousand Oaks-Ventura

    California · 19112

    Office

    $559.78

    Facility

    $353.30

    $37.50 higher than Austin for the office setting.

  • Redding

    California · 19112

    Office

    $525.55

    Facility

    $334.10

    $3.27 higher than Austin for the office setting.

  • Rest Of California

    California · 19112

    Office

    $525.55

    Facility

    $334.10

    $3.27 higher than Austin for the office setting.

  • Riverside-San Bernardino-Ontario

    California · 19112

    Office

    $536.37

    Facility

    $344.92

    $14.09 higher than Austin for the office setting.

  • Sacramento-Roseville-Folsom

    California · 19112

    Office

    $551.23

    Facility

    $348.07

    $28.95 higher than Austin for the office setting.

  • Salinas

    California · 19112

    Office

    $549.22

    Facility

    $346.75

    $26.94 higher than Austin for the office setting.

  • San Diego-Chula Vista-Carlsbad

    California · 19112

    Office

    $562.17

    Facility

    $353.25

    $39.89 higher than Austin for the office setting.

  • San Francisco-Oakland-Berkeley (Marin Cnty)

    California · 19112

    Office

    $641.91

    Facility

    $395.60

    $119.63 higher than Austin for the office setting.

  • San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)

    California · 19112

    Office

    $640.76

    Facility

    $394.45

    $118.48 higher than Austin for the office setting.

  • San Jose-Sunnyvale-Santa Clara (San Benito Cnty)

    California · 19112

    Office

    $657.50

    Facility

    $405.60

    $135.22 higher than Austin for the office setting.

  • San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)

    California · 19112

    Office

    $652.81

    Facility

    $400.91

    $130.53 higher than Austin for the office setting.

  • San Luis Obispo-Paso Robles

    California · 19112

    Office

    $540.52

    Facility

    $341.55

    $18.24 higher than Austin for the office setting.

  • Santa Cruz-Watsonville

    California · 19112

    Office

    $567.47

    Facility

    $355.22

    $45.19 higher than Austin for the office setting.

  • Santa Maria-Santa Barbara

    California · 19112

    Office

    $551.28

    Facility

    $347.60

    $29.00 higher than Austin for the office setting.

  • Santa Rosa-Petaluma

    California · 19112

    Office

    $573.11

    Facility

    $358.59

    $50.83 higher than Austin for the office setting.

  • Stockton

    California · 19112

    Office

    $525.55

    Facility

    $334.10

    $3.27 higher than Austin for the office setting.

  • Vallejo

    California · 19112

    Office

    $605.92

    Facility

    $375.68

    $83.64 higher than Austin for the office setting.

  • Visalia

    California · 19112

    Office

    $525.55

    Facility

    $334.10

    $3.27 higher than Austin for the office setting.

  • Yuba City

    California · 19112

    Office

    $525.55

    Facility

    $334.10

    $3.27 higher than Austin for the office setting.

  • Colorado

    Colorado · 19112

    Office

    $522.06

    Facility

    $336.20

    $0.22 lower than Austin for the office setting.

  • Connecticut

    Connecticut · 19112

    Office

    $542.05

    Facility

    $353.91

    $19.77 higher than Austin for the office setting.

  • Delaware

    Delaware · 19112

    Office

    $498.73

    Facility

    $326.14

    $23.55 lower than Austin for the office setting.

  • Fort Lauderdale

    Florida · 19112

    Office

    $537.47

    Facility

    $360.51

    $15.19 higher than Austin for the office setting.

  • Rest Of Florida

    Florida · 19112

    Office

    $507.34

    Facility

    $340.34

    $14.94 lower than Austin for the office setting.

  • Atlanta

    Georgia · 19112

    Office

    $518.41

    Facility

    $340.93

    $3.87 lower than Austin for the office setting.

  • Rest Of Georgia

    Georgia · 19112

    Office

    $474.58

    Facility

    $318.76

    $47.70 lower than Austin for the office setting.

  • Hawaii, Guam

    Hawaii · 19112

    Office

    $539.17

    Facility

    $340.55

    $16.89 higher than Austin for the office setting.

  • Iowa

    Iowa · 19112

    Office

    $455.76

    Facility

    $295.93

    $66.52 lower than Austin for the office setting.

  • Idaho

    Idaho · 19112

    Office

    $460.07

    Facility

    $299.36

    $62.21 lower than Austin for the office setting.

  • East St. Louis

    Illinois · 19112

    Office

    $512.05

    Facility

    $351.34

    $10.23 lower than Austin for the office setting.

  • Rest Of Illinois

    Illinois · 19112

    Office

    $494.40

    Facility

    $334.91

    $27.88 lower than Austin for the office setting.

  • Suburban Chicago

    Illinois · 19112

    Office

    $542.00

    Facility

    $362.59

    $19.72 higher than Austin for the office setting.

  • Indiana

    Indiana · 19112

    Office

    $462.94

    Facility

    $301.01

    $59.34 lower than Austin for the office setting.

  • Kansas

    Kansas · 19112

    Office

    $455.55

    Facility

    $297.63

    $66.73 lower than Austin for the office setting.

  • Kentucky

    Kentucky · 19112

    Office

    $464.19

    Facility

    $308.89

    $58.09 lower than Austin for the office setting.

  • New Orleans

    Louisiana · 19112

    Office

    $489.74

    Facility

    $325.36

    $32.54 lower than Austin for the office setting.

  • Rest Of Louisiana

    Louisiana · 19112

    Office

    $464.25

    Facility

    $309.65

    $58.03 lower than Austin for the office setting.

  • Metropolitan Boston

    Massachusetts · 19112

    Office

    $574.58

    Facility

    $366.00

    $52.30 higher than Austin for the office setting.

  • Rest Of Massachusetts

    Massachusetts · 19112

    Office

    $519.27

    Facility

    $335.32

    $3.01 lower than Austin for the office setting.

  • Baltimore/Surr. Cntys

    Maryland · 19112

    Office

    $541.07

    Facility

    $353.64

    $18.79 higher than Austin for the office setting.

  • Rest Of Maryland

    Maryland · 19112

    Office

    $508.34

    Facility

    $331.56

    $13.94 lower than Austin for the office setting.

  • Rest Of Maine

    Maine · 19112

    Office

    $465.09

    Facility

    $304.38

    $57.19 lower than Austin for the office setting.

  • Southern Maine

    Maine · 19112

    Office

    $490.11

    Facility

    $316.99

    $32.17 lower than Austin for the office setting.

  • Detroit

    Michigan · 19112

    Office

    $516.65

    Facility

    $348.08

    $5.63 lower than Austin for the office setting.

  • Rest Of Michigan

    Michigan · 19112

    Office

    $479.76

    Facility

    $320.27

    $42.52 lower than Austin for the office setting.

  • Minnesota

    Minnesota · 19112

    Office

    $492.03

    Facility

    $312.28

    $30.25 lower than Austin for the office setting.

  • Metropolitan Kansas City

    Missouri · 19112

    Office

    $483.68

    Facility

    $319.65

    $38.60 lower than Austin for the office setting.

  • Metropolitan St. Louis

    Missouri · 19112

    Office

    $489.05

    Facility

    $322.75

    $33.23 lower than Austin for the office setting.

  • Rest Of Missouri

    Missouri · 19112

    Office

    $456.78

    Facility

    $306.20

    $65.50 lower than Austin for the office setting.

  • Mississippi

    Mississippi · 19112

    Office

    $448.51

    Facility

    $298.10

    $73.77 lower than Austin for the office setting.

  • Montana**

    Montana · 19112

    Office

    $505.62

    Facility

    $330.94

    $16.66 lower than Austin for the office setting.

  • North Carolina

    North Carolina · 19112

    Office

    $470.19

    Facility

    $307.21

    $52.09 lower than Austin for the office setting.

  • North Dakota**

    North Dakota · 19112

    Office

    $485.65

    Facility

    $310.96

    $36.63 lower than Austin for the office setting.

  • Nebraska

    Nebraska · 19112

    Office

    $457.91

    Facility

    $296.67

    $64.37 lower than Austin for the office setting.

  • New Hampshire

    New Hampshire · 19112

    Office

    $515.74

    Facility

    $333.89

    $6.54 lower than Austin for the office setting.

  • Northern Nj

    New Jersey · 19112

    Office

    $571.48

    Facility

    $368.84

    $49.20 higher than Austin for the office setting.

  • Rest Of New Jersey

    New Jersey · 19112

    Office

    $545.94

    Facility

    $355.18

    $23.66 higher than Austin for the office setting.

  • New Mexico

    New Mexico · 19112

    Office

    $483.58

    Facility

    $323.40

    $38.70 lower than Austin for the office setting.

  • Nevada**

    Nevada · 19112

    Office

    $500.40

    Facility

    $325.54

    $21.88 lower than Austin for the office setting.

  • Nyc Suburbs/Long Island

    New York · 19112

    Office

    $608.31

    Facility

    $400.61

    $86.03 higher than Austin for the office setting.

  • Poughkpsie/N Nyc Suburbs

    New York · 19112

    Office

    $551.41

    Facility

    $360.13

    $29.13 higher than Austin for the office setting.

  • Queens

    New York · 19112

    Office

    $591.87

    Facility

    $385.39

    $69.59 higher than Austin for the office setting.

  • Rest Of New York

    New York · 19112

    Office

    $478.27

    Facility

    $312.32

    $44.01 lower than Austin for the office setting.

  • Ohio

    Ohio · 19112

    Office

    $475.68

    Facility

    $316.19

    $46.60 lower than Austin for the office setting.

  • Oklahoma

    Oklahoma · 19112

    Office

    $460.93

    Facility

    $304.93

    $61.35 lower than Austin for the office setting.

  • Portland

    Oregon · 19112

    Office

    $537.67

    Facility

    $343.59

    $15.39 higher than Austin for the office setting.

  • Rest Of Oregon

    Oregon · 19112

    Office

    $494.28

    Facility

    $320.29

    $28.00 lower than Austin for the office setting.

  • Metropolitan Philadelphia

    Pennsylvania · 19112

    Office

    $528.70

    Facility

    $346.85

    $6.42 higher than Austin for the office setting.

  • Rest Of Pennsylvania

    Pennsylvania · 19112

    Office

    $475.30

    Facility

    $314.93

    $46.98 lower than Austin for the office setting.

  • Puerto Rico

    Puerto Rico · 19112

    Office

    $509.01

    Facility

    $332.40

    $13.27 lower than Austin for the office setting.

  • Rhode Island

    Rhode Island · 19112

    Office

    $515.89

    Facility

    $335.43

    $6.39 lower than Austin for the office setting.

  • South Carolina

    South Carolina · 19112

    Office

    $474.18

    Facility

    $312.77

    $48.10 lower than Austin for the office setting.

  • South Dakota**

    South Dakota · 19112

    Office

    $483.29

    Facility

    $308.60

    $38.99 lower than Austin for the office setting.

  • Tennessee

    Tennessee · 19112

    Office

    $458.40

    Facility

    $299.61

    $63.88 lower than Austin for the office setting.

  • Utah

    Utah · 19112

    Office

    $481.37

    Facility

    $317.16

    $40.91 lower than Austin for the office setting.

  • Virginia

    Virginia · 19112

    Office

    $489.85

    Facility

    $318.14

    $32.43 lower than Austin for the office setting.

  • Virgin Islands

    United States Virgin Islands · 19112

    Office

    $509.01

    Facility

    $332.40

    $13.27 lower than Austin for the office setting.

  • Vermont

    Vermont · 19112

    Office

    $485.54

    Facility

    $312.60

    $36.74 lower than Austin for the office setting.

  • Rest Of Washington

    Washington · 19112

    Office

    $517.68

    Facility

    $333.74

    $4.60 lower than Austin for the office setting.

  • Seattle (King Cnty)

    Washington · 19112

    Office

    $584.72

    Facility

    $370.38

    $62.44 higher than Austin for the office setting.

  • Wisconsin

    Wisconsin · 19112

    Office

    $467.73

    Facility

    $300.38

    $54.55 lower than Austin for the office setting.

  • West Virginia

    West Virginia · 19112

    Office

    $474.64

    Facility

    $322.83

    $47.64 lower than Austin for the office setting.

  • Wyoming**

    Wyoming · 19112

    Office

    $496.92

    Facility

    $322.23

    $25.36 lower than Austin for the office setting.

See how rates vary across the country

19112 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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.

$440.25

$591.53

Color shows the midpoint of each state’s locality range.

View all state and territory rates as a table
State / territoryRate rangeLocalities
AK$575.121
AL$447.541
AR$440.251
AZ$490.041
CA$525.55–$657.5029
CO$522.061
CT$542.051
DC$578.141
DE$498.731
FL$507.34–$571.543
GA$474.58–$518.412
GU$539.171
HI$539.171
IA$455.761
ID$460.071
IL$494.40–$551.984
IN$462.941
KS$455.551
KY$464.191
LA$464.25–$489.742
MA$519.27–$574.582
MD$508.34–$578.143
ME$465.09–$490.112
MI$479.76–$516.652
MN$492.031
MO$456.78–$489.053
MS$448.511
MT$505.621
NC$470.191
ND$485.651
NE$457.911
NH$515.741
NJ$545.94–$571.482
NM$483.581
NV$500.401
NY$478.27–$608.315
OH$475.681
OK$460.931
OR$494.28–$537.672
PA$475.30–$528.702
PR$509.011
RI$515.891
SC$474.181
SD$483.291
TN$458.401
TX$471.97–$522.288
UT$481.371
VA$489.85–$578.142
VI$509.011
VT$485.541
WA$517.68–$584.722
WI$467.731
WV$474.641
WY$496.921

Explore 19112 on the national rate map →

Where does this rate apply?

Austin is a Medicare payment area. Our Census mapping connects it to 31 cities and communities in Texas, including the examples shown here.

Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.

Browse all communities in Texas →

Why are the office and facility amounts different?

For 19112 in Austin, the physician’s office rate is $522.28 and the facility-setting rate is $337.46: a difference of $184.82.

The calculation uses a different practice-expense RVU for each setting. Both amounts here are physician fee-schedule amounts. The facility figure does not include a hospital’s separate charges, so this comparison does not tell you the total cost of receiving care in each setting.

See the inputs behind this difference →

Use this rate

What is a percentage of Medicare worth?

Turn a percentage into dollars for 19112 in Austin. This uses the base rate on this page, so the locality and release stay consistent.

Reference amount per service

$574.51

$522.28 × 110% = $574.51

A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.

Working with a whole code list?

Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.

Compare your contract offer →

How this local rate is calculated

Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 19112 in Austin.

PPRRVU2026_Oct_nonQPP.csv

1,669

Code
19112
Physician work
3.71
Practice expense
10.42
Malpractice
1.01

GPCI2026.csv

96

Locality
Austin
Physician work
1.002
Practice expense
1.058
Malpractice
0.886
Office / nonfacility calculation for 19112 in Austin
ComponentRVULocality factorAdjusted
Physician work3.71× 1.0023.7174
Practice expense10.42× 1.05811.0244
Malpractice1.01× 0.8860.8949
Total RVUs15.6366
Conversion factor× 33.4009

Office / nonfacility rate, Austin$522.28

Open 19112 in the RVU calculator →

Explore RVUs, geographic factors and the full formula

Office / nonfacility

Office / nonfacility calculation inputs
ComponentRVULocal GPCI
Work3.711.002
Practice expense10.421.058
Malpractice1.010.886

(3.71 × 1.002 + 10.42 × 1.058 + 1.01 × 0.886) × $33.4009 = $522.28

Facility

Facility calculation inputs
ComponentRVULocal GPCI
Work3.711.002
Practice expense5.191.058
Malpractice1.010.886

(3.71 × 1.002 + 5.19 × 1.058 + 1.01 × 0.886) × $33.4009 = $337.46

The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.

How this rate has changed

19112 · Office / nonfacility

$522.28

Effective 2026-10-01

The base rate is $69.95 higher than on 2025-10-01, moving from $452.33 to $522.28 (15.5%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $452.33changed to$522.28

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 3.81 changed to 3.71
    • Practice expense RVU 8.87 changed to 10.42
    • Malpractice RVU 0.98 changed to 1.01
    • Work GPCI 1.000 changed to 1.002
    • Practice expense GPCI 1.046 changed to 1.058
    • Malpractice GPCI 0.914 changed to 0.886

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    Earliest loaded release: $452.33

    Held through RVU25B, RVU25C, RVU25D.

Explore release dates and calculate this code in an earlier period →

Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.

Inspect every release and its CMS source
Effective fromOffice / nonfacilityFacilityCMS release
2026-10-01$522.28$337.46RVU26D
2026-07-01$522.28$337.46RVU26C
2026-04-01$522.28$337.46RVU26B
2026-01-01$522.28$337.46RVU26A
2025-10-01$452.33$325.78RVU25D
2025-07-01$452.33$325.78RVU25C
2025-04-01$452.33$325.78RVU25B
2025-01-01$452.33$325.78RVU25A

19112 billing questions

Can this code be used for a breast mass biopsy?

No. This code describes excision of a duct fistula, not diagnostic sampling of a mass. An open or percutaneous biopsy code may apply when the service is tissue sampling.

What documentation supports reporting 19112?

The operative report should identify the duct fistula, its breast location, and the excision performed. Document the side when the procedure is unilateral.

How is bilateral excision reported?

CMS pays bilateral reporting with modifier 50 at 150%. The documentation should support excision of a duct fistula on both sides.

What postoperative care is included?

The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.

When is assistant-at-surgery payment allowed?

CMS allows assistant-at-surgery payment only when medical necessity is documented. Co-surgeons and team surgery are not permitted for this code.

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.

RVUs for 19112PPRRVU2026_Oct_nonQPP.csv, line 1,669 (RVU26D)
Geographic factors for AustinGPCI2026.csv, line 96 (RVU26D)
Open CMS sourceHow this rate is calculatedBuild a fee sheet