FeeBase
Log inGet started
Menu

CPT code 19085: Breast biopsy2026 Medicare rate & RVUs in Chicago

Reports percutaneous tissue sampling of a breast lesion targeted with MRI, for the first lesion biopsied using MRI guidance.

CMS RVU26DEffective Oct 1, 2026One payment locality7.9K Medicare services in 2024

In Chicago, Medicare pays $737.70 for 19085 in the office and $167.38 when it’s performed in a hospital or facility.

$737.70Office (non-facility)
$167.38Hospital or facility
+2.6%vs the national office rate ($718.79)

Check a contract rate as a % of Medicare · 19085 nationwide

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

We’ll open 19085 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Chicago
  2. What 19085 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

What 19085 covers

This service covers percutaneous sampling of a breast lesion located and targeted with magnetic resonance imaging, typically when the lesion is not adequately accessible for targeting by ultrasound or mammography. A radiologist or other qualified breast imager guides a biopsy needle to the lesion, obtains tissue, and may place a marker clip and image the specimen. The code represents the biopsy with MRI guidance, not a diagnostic breast MRI alone or surgical removal of the lesion.

Report 19085 for the first lesion sampled with MRI guidance; report 19086 for each additional lesion sampled with that guidance. The record should support the targeted lesion, MRI guidance, tissue sampling, and any marker placement or specimen imaging performed. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. In a same-session multiple-procedure claim, the highest-valued procedure is paid in full and others at 50%; 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.

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.

How Chicago compares for 19085

Across 109 of 109 payment localities, the office rate for 19085 runs from $630.14 in Arkansas to $986.53 in San Jose-Sunnyvale-Santa Clara (San Benito Cnty). Chicago pays $737.70. The RVUs are the same everywhere; the geographic indexes change the dollars.

19085 in Chicago vs other payment areas
  1. Chicago · this page$737.70
  2. East St. Louis · Illinois$683.56−$54.14
  3. Rest Of Illinois · Illinois$674.17−$63.53
  4. Suburban Chicago · Illinois$744.53+$6.83
  5. Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) · California$827.42+$89.72
  6. Dc + Md/Va Suburbs · District of Columbia$831.27+$93.57
  7. Miami · Florida$760.79+$23.09

Other areas in Illinois first, then benchmark localities. Bars start at $0.

Every other payment area

19085 in every other Medicare payment locality
Payment localityOfficeFacility
ManhattanNew York$828.57$169.15
Alaska*Alaska$811.08$206.71
AlabamaAlabama$640.15$143.60
ArkansasArkansas$630.14$142.67
ArizonaArizona$698.86$148.97
BakersfieldCalifornia$772.97$151.01
ChicoCalifornia$771.88$149.92
El CentroCalifornia$771.94$149.98

19085 rates by state

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

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.

$630.14

$879.20

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

View every state and territory as a table
19085 office rate range by state
State / territoryOffice rate rangeLocalities
AK$811.081
AL$640.151
AR$630.141
AZ$698.861
CA$771.88–$986.5329
CO$755.321
CT$768.931
DC$831.271
DE$711.141
FL$698.77–$760.793
GA$657.47–$730.912
GU$794.491
HI$794.491
IA$661.711
ID$665.541
IL$674.17–$744.534
IN$669.821
KS$656.491
KY$652.471
LA$650.62–$685.652
MA$749.50–$836.542
MD$726.08–$831.273
ME$667.29–$709.182
MI$669.09–$706.212
MN$727.621
MO$637.27–$690.563
MS$633.931
MT$718.761
NC$675.141
ND$711.841
NE$666.201
NH$741.461
NJ$778.81–$821.222
NM$672.291
NV$717.421
NY$685.89–$847.635
OH$667.681
OK$653.211
OR$712.96–$783.022
PA$669.89–$747.312
PR$725.091
RI$739.201
SC$672.311
SD$711.021
TN$659.821
TX$664.99–$751.838
UT$682.281
VA$705.35–$831.272
VI$725.091
VT$707.131
WA$748.73–$856.172
WI$685.981
WV$646.731
WY$715.751

See 19085 in every payment locality

How the 19085 rate is calculated

Each of 19085’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 · 19085

RVUs × geographic indexes × conversion factor

Work3.55

3.55 RVUs× 1.000 GPCI

Practice expense17.62

17.62 RVUs× 1.000 GPCI

Malpractice0.35

0.35 RVUs× 1.000 GPCI

Adjusted RVUs

21.5200

Conversion factor

$33.4009

Medicare rate

$718.79

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Chicago inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

1,663

Code
19085
Physician work
3.55
Practice expense
17.62
Malpractice
0.35

GPCI2026.csv

48

Locality
Chicago
Physician work
1.007
Practice expense
1.005
Malpractice
2.295
Office calculation for 19085 in Chicago
ComponentRVULocality factorAdjusted
Physician work3.55× 1.0073.5748
Practice expense17.62× 1.00517.7081
Malpractice0.35× 2.2950.8032
Total RVUs22.0862
Conversion factor× 33.4009

Office rate, Chicago$737.70

Office: (3.55 × 1.007 + 17.62 × 1.005 + 0.35 × 2.295) × $33.4009 = $737.70

Facility: (3.55 × 1.007 + 0.63 × 1.005 + 0.35 × 2.295) × $33.4009 = $167.38

Open 19085 in the RVU calculator

Payment rules and modifiers for 19085

The CMS indicators that decide how 19085 is paid alongside other services.

CMS payment indicators · 19085

Breast biopsy

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
Assistant at surgery (80/81/82/AS)0Not paid without supporting documentation.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.

What modifiers do to the payment

Modifier 50 · payment effect

With and without the modifier

19085 without 50 · national office

$718.79

Breast biopsy

19085-50 · Bilateral: 150%

$1,078.19

Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).

When to use modifier 50

Codes related to 19085

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

Codes related to 19085
CodeHow it relatesOffice range, Chicago
Add-on codes
19086Breast biopsyAdd-on code for each additional lesion sampled with MRI guidance.$563.33
Used instead
19083Breast biopsyPercutaneous breast biopsy when ultrasound, rather than MRI, guides the first lesion.$492.86
19081Breast biopsyPercutaneous breast biopsy when stereotactic guidance, rather than MRI, targets the first lesion.$495.99
Same family
19084Breast biopsyAdditional-lesion breast biopsy code using ultrasound guidance.$366.17
19082Breast biopsyAdditional-lesion breast biopsy code using stereotactic guidance.$372.65

How 19085 has changed in Chicago

19085 · Office / nonfacility

$737.70

Effective 2026-10-01

The base rate is $0.64 higher than on 2025-10-01, moving from $737.06 to $737.70 (0.1%).

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

    $737.06changed to$737.70

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 3.64 changed to 3.55
    • Practice expense RVU 18.04 changed to 17.62
    • Malpractice RVU 0.33 changed to 0.35
    • Practice expense GPCI 1.023 changed to 1.005
    • Malpractice GPCI 2.018 changed to 2.295

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $780.98changed to$737.06

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 18.70 changed to 18.04

    Held through RVU25B, RVU25C, RVU25D.

  3. October 1, 2024

    RVU24D

    $867.11changed to$780.98

    • Conversion factor 34.6062 changed to 33.2875
    • Practice expense RVU 19.92 changed to 18.70
    • Malpractice RVU 0.31 changed to 0.33
    • Work GPCI 1.011 changed to 1.007
    • Practice expense GPCI 1.044 changed to 1.023
    • Malpractice GPCI 1.871 changed to 2.018

  4. July 1, 2022

    RVU22C

    $949.78changed to$867.11

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 22.01 changed to 19.92
    • Malpractice RVU 0.30 changed to 0.31

  5. January 1, 2021

    RVU21A

    $987.03changed to$949.78

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 22.24 changed to 22.01
    • Work GPCI 1.009 changed to 1.011
    • Practice expense GPCI 1.039 changed to 1.044
    • Malpractice GPCI 1.898 changed to 1.871

    Held through RVU21B.

  6. January 1, 2020

    RVU20A

    $1027.54changed to$987.03

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 23.43 changed to 22.24
    • Malpractice RVU 0.32 changed to 0.30
    • Work GPCI 1.008 changed to 1.009
    • Practice expense GPCI 1.034 changed to 1.039
    • Malpractice GPCI 1.925 changed to 1.898

    Held through RVU20B, RVU20C, RVU20D.

  7. January 1, 2019

    RVU19A

    $1068.15changed to$1027.54

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 24.57 changed to 23.43
    • Malpractice RVU 0.31 changed to 0.32

    Held through RVU19B, RVU19C, RVU19D.

  8. January 1, 2018

    RVU18AR1

    $1085.30changed to$1068.15

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 24.93 changed to 24.57
    • Malpractice RVU 0.37 changed to 0.31
    • Work GPCI 1.012 changed to 1.008
    • Practice expense GPCI 1.036 changed to 1.034
    • Malpractice GPCI 1.972 changed to 1.925

    Held through RVU18B, RVU18C, RVU18D.

  9. January 1, 2017

    RVU17A

    $1097.72changed to$1085.30

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 25.22 changed to 24.93
    • Malpractice RVU 0.40 changed to 0.37
    • Work GPCI 1.016 changed to 1.012
    • Practice expense GPCI 1.037 changed to 1.036
    • Malpractice GPCI 2.019 changed to 1.972

    Held through RVU17B, RVU17C, RVU17D.

  10. January 1, 2016

    RVU16A

    $1110.94changed to$1097.72

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 24.67 changed to 25.22
    • Malpractice RVU 0.81 changed to 0.40

    Held through RVU16B, RVU16C, RVU16D.

  11. July 1, 2015

    RVU15C

    $1105.41changed to$1110.94

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  12. January 1, 2015

    RVU15A

    $1094.60changed to$1105.41

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 24.23 changed to 24.67
    • Malpractice RVU 0.75 changed to 0.81
    • Work GPCI 1.023 changed to 1.016
    • Practice expense GPCI 1.044 changed to 1.037
    • Malpractice GPCI 2.048 changed to 2.019

    Held through RVU15B.

  13. January 1, 2014

    RVU14A

    No ratechanged to$1094.60

    Held through RVU14B, RVU14C, RVU14D.

  14. January 1, 2013

    RVU13AR

    Earliest loaded release: No rate

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$737.70$167.38RVU26D
2026-07-01$737.70$167.38RVU26C
2026-04-01$737.70$167.38RVU26B
2026-01-01$737.70$167.38RVU26A
2025-10-01$737.06$184.12RVU25D
2025-07-01$737.06$184.12RVU25C
2025-04-01$737.06$184.12RVU25B
2025-01-01$737.06$184.12RVU25A
2024-10-01$780.98$188.11RVU24D
2022-07-01$867.11$194.75RVU22C
2021-04-01$949.78$196.08RVU21B
2021-01-01$949.78$196.08RVU21A
2020-10-01$987.03$203.34RVU20D
2020-07-01$987.03$203.34RVU20C
2020-04-01$987.03$203.34RVU20B
2020-01-01$987.03$203.34RVU20A
2019-10-01$1,027.54$204.37RVU19D
2019-07-01$1,027.54$204.37RVU19C
2019-04-01$1,027.54$204.37RVU19B
2019-01-01$1,027.54$204.37RVU19A
2018-10-01$1,068.15$203.45RVU18D
2018-07-01$1,068.15$203.45RVU18C
2018-04-01$1,068.15$203.45RVU18B
2018-01-01$1,068.15$203.45RVU18AR1
2017-10-01$1,085.30$208.95RVU17D
2017-07-01$1,085.30$208.95RVU17C
2017-04-01$1,085.30$208.95RVU17B
2017-01-01$1,085.30$208.95RVU17A
2016-10-01$1,097.72$211.45RVU16D
2016-07-01$1,097.72$211.45RVU16C
2016-04-01$1,097.72$211.45RVU16B
2016-01-01$1,097.72$211.45RVU16A
2015-10-01$1,110.94$241.96RVU15D
2015-07-01$1,110.94$241.96RVU15C
2015-04-01$1,105.41$240.76RVU15B
2015-01-01$1,105.41$240.76RVU15A
2014-10-01$1,094.60$238.16RVU14D
2014-07-01$1,094.60$238.16RVU14C
2014-04-01$1,094.60$238.16RVU14B
2014-01-01$1,094.60$238.16RVU14A
2013-10-01Not in this releaseNot in this releaseRVU13D
2013-07-01Not in this releaseNot in this releaseRVU13C
2013-04-01Not in this releaseNot in this releaseRVU13B
2013-01-01Not in this releaseNot in this releaseRVU13AR

Price 19085 for an earlier date of service

Where the Chicago rate applies

Chicago is a Medicare payment area, not a city. Our Census mapping connects it to 137 cities and communities in Illinois. Some span more than one payment area; confirm with the service ZIP.

Browse all communities in Illinois

19085 billing questions

When is 19085 used instead of 19083?

Use 19085 when MRI guides the percutaneous breast biopsy. Use 19083 when ultrasound provides the guidance.

How is a second MRI-guided lesion reported?

Report 19086 for each additional lesion sampled with MRI guidance, along with 19085 for the first lesion.

Are marker placement and specimen imaging separately reported?

Marker placement and imaging of the biopsy specimen are included in 19085 when performed; they are not separate services under this code.

How should bilateral MRI-guided biopsies be reported?

CMS identifies this as a bilateral procedure; modifier 50 is paid at 150%. Document the biopsies performed on both breasts.

What documentation supports 19085?

Document the breast lesion targeted, MRI guidance, and percutaneous tissue sampling. Record marker placement and specimen imaging when performed.

Can an assistant or co-surgeon be billed?

Assistant-at-surgery payment requires documentation of medical necessity. CMS does not permit co-surgeons or team surgery 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 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 19085PPRRVU2026_Oct_nonQPP.csv, line 1,663 (RVU26D)
Geographic factors for ChicagoGPCI2026.csv, line 48 (RVU26D)

Open CMS sourceHow we calculate rates

Did this answer your question about what 19085 pays in Chicago?

Tell us what you were actually trying to work out. We’ll answer you directly, or build the page that does.

Fee sheets

Put 19085 and the rest of your codes on one sheet

Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.

Build my fee sheetOr price your code list free →