Billing code 19086: Breast biopsyMedicare rate & RVUs in Delaware
Report this add-on for tissue sampling of an additional breast lesion using MRI guidance, alongside the primary MRI-guided breast biopsy code.
In Delaware, Medicare pays $546.98 for 19086 in the office and $75.08 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 19086 nationwide
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 11 sections
What 19086 covers
This code covers needle sampling of an additional breast target identified and accessed with MRI guidance. It is typically performed by a radiologist or other qualified breast-imaging clinician in an outpatient imaging center or hospital MRI suite. The biopsy may include placement of a marker at the sampled site and imaging of the specimen when performed. The first MRI-guided lesion is reported separately with the primary code.
Report one unit for each additional lesion sampled under MRI guidance, supported by documentation identifying the targets and confirming MRI guidance and tissue sampling. Do not use this code by itself: it is an add-on reported with the primary MRI-guided breast biopsy procedure. Under the CMS rule for this code, payment is within the primary procedure’s global period. The documentation should distinguish each additional target from the first lesion and from targets sampled using another guidance method.
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 Delaware compares for 19086
Across 109 of 109 payment localities, the office rate for 19086 runs from $481.51 in Arkansas to $772.83 in San Jose-Sunnyvale-Santa Clara (San Benito Cnty). Delaware pays $546.98. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Delaware · this page$546.98
- Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) · California$643.00+$96.02
- Dc + Md/Va Suburbs · District of Columbia$643.87+$96.89
- Miami · Florida$581.82+$34.84
- Chicago · Illinois$563.33+$16.35
- Manhattan · New York$639.34+$92.36
- Alaska* · Alaska$611.87+$64.89
Other areas in Delaware first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $489.61 | $71.69 |
| ArkansasArkansas | $481.51 | $71.23 |
| ArizonaArizona | $537.16 | $74.34 |
| BakersfieldCalifornia | $598.90 | $75.42 |
| ChicoCalifornia | $598.37 | $74.88 |
| El CentroCalifornia | $598.40 | $74.91 |
| FresnoCalifornia | $598.37 | $74.88 |
| Hanford-CorcoranCalifornia | $598.37 | $74.88 |
| MaderaCalifornia | $598.37 | $74.88 |
| MercedCalifornia | $598.37 | $74.88 |
| ModestoCalifornia | $598.37 | $74.88 |
| NapaCalifornia | $709.34 | $79.82 |
| Oxnard-Thousand Oaks-VenturaCalifornia | $641.51 | $76.95 |
| ReddingCalifornia | $598.37 | $74.88 |
| Rest Of CaliforniaCalifornia | $598.37 | $74.88 |
| Riverside-San Bernardino-OntarioCalifornia | $600.23 | $76.74 |
| Sacramento-Roseville-FolsomCalifornia | $632.21 | $76.72 |
| SalinasCalifornia | $629.96 | $76.38 |
| San Diego-Chula Vista-CarlsbadCalifornia | $648.00 | $76.75 |
| San Francisco-Oakland-Berkeley (Marin Cnty)California | $755.88 | $82.41 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)California | $755.68 | $82.22 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty)California | $772.83 | $84.08 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)California | $772.04 | $83.29 |
| San Luis Obispo-Paso RoblesCalifornia | $619.37 | $75.34 |
| Santa Cruz-WatsonvilleCalifornia | $656.71 | $76.39 |
| Santa Maria-Santa BarbaraCalifornia | $633.20 | $76.28 |
| Santa Rosa-PetalumaCalifornia | $663.60 | $77.06 |
| StocktonCalifornia | $598.37 | $74.88 |
| VallejoCalifornia | $709.06 | $79.54 |
| VisaliaCalifornia | $598.37 | $74.88 |
| Yuba CityCalifornia | $598.37 | $74.88 |
| ColoradoColorado | $583.84 | $75.64 |
| ConnecticutConnecticut | $593.09 | $78.68 |
| Fort LauderdaleFlorida | $564.06 | $80.21 |
| Rest Of FloridaFlorida | $534.49 | $77.87 |
| AtlantaGeorgia | $562.25 | $76.98 |
| Rest Of GeorgiaGeorgia | $501.47 | $75.42 |
| Hawaii, GuamHawaii | $617.63 | $74.56 |
| IowaIowa | $508.19 | $71.15 |
| IdahoIdaho | $511.06 | $71.64 |
| East St. LouisIllinois | $519.81 | $80.39 |
| Rest Of IllinoisIllinois | $513.83 | $77.75 |
| Suburban ChicagoIllinois | $571.10 | $80.57 |
| IndianaIndiana | $514.55 | $71.79 |
| KansasKansas | $503.42 | $71.64 |
| KentuckyKentucky | $498.43 | $73.82 |
| New OrleansLouisiana | $525.08 | $75.63 |
| Rest Of LouisianaLouisiana | $496.72 | $74.02 |
| Metropolitan BostonMassachusetts | $649.65 | $79.36 |
| Rest Of MassachusettsMassachusetts | $578.79 | $75.85 |
| Baltimore/Surr. CntysMaryland | $591.06 | $78.56 |
| Rest Of MarylandMaryland | $559.10 | $75.74 |
| Rest Of MaineMaine | $511.91 | $72.48 |
| Southern MaineMaine | $546.63 | $73.29 |
| DetroitMichigan | $539.92 | $79.01 |
| Rest Of MichiganMichigan | $511.37 | $75.29 |
| MinnesotaMinnesota | $563.28 | $71.80 |
| Metropolitan Kansas CityMissouri | $523.20 | $74.70 |
| Metropolitan St. LouisMissouri | $529.69 | $74.98 |
| Rest Of MissouriMissouri | $485.58 | $73.86 |
| MississippiMississippi | $483.76 | $72.52 |
| Montana**Montana | $553.11 | $75.47 |
| North CarolinaNorth Carolina | $518.35 | $72.72 |
| North Dakota**North Dakota | $549.75 | $72.11 |
| NebraskaNebraska | $511.99 | $71.13 |
| New HampshireNew Hampshire | $572.43 | $75.21 |
| Northern NjNew Jersey | $635.36 | $81.31 |
| Rest Of New JerseyNew Jersey | $600.96 | $79.38 |
| New MexicoNew Mexico | $513.73 | $75.74 |
| Nevada**Nevada | $552.66 | $74.55 |
| Nyc Suburbs/Long IslandNew York | $654.06 | $86.16 |
| Poughkpsie/N Nyc SuburbsNew York | $603.36 | $80.35 |
| QueensNew York | $648.29 | $83.72 |
| Rest Of New YorkNew York | $527.02 | $73.27 |
| OhioOhio | $510.68 | $74.60 |
| OklahomaOklahoma | $499.60 | $73.08 |
| PortlandOregon | $606.81 | $76.16 |
| Rest Of OregonOregon | $549.48 | $73.76 |
| Metropolitan PhiladelphiaPennsylvania | $575.30 | $78.08 |
| Rest Of PennsylvaniaPennsylvania | $512.76 | $74.30 |
| Puerto RicoPuerto Rico | $558.41 | $75.52 |
| Rhode IslandRhode Island | $569.74 | $76.35 |
| South CarolinaSouth Carolina | $515.15 | $73.82 |
| South Dakota**South Dakota | $549.35 | $71.72 |
| TennesseeTennessee | $506.05 | $71.88 |
| AustinTexas | $580.91 | $75.58 |
| BeaumontTexas | $508.77 | $74.12 |
| BrazoriaTexas | $547.95 | $74.61 |
| DallasTexas | $550.89 | $75.17 |
| Fort WorthTexas | $546.08 | $75.14 |
| GalvestonTexas | $549.20 | $74.91 |
| HoustonTexas | $552.31 | $78.02 |
| Rest Of TexasTexas | $527.66 | $74.39 |
| UtahUtah | $523.24 | $74.27 |
| VirginiaVirginia | $543.15 | $73.63 |
| Virgin IslandsUnited States Virgin Islands | $558.41 | $75.52 |
| VermontVermont | $545.43 | $72.57 |
| Rest Of WashingtonWashington | $578.41 | $75.46 |
| Seattle (King Cnty)Washington | $665.88 | $79.83 |
| WisconsinWisconsin | $528.68 | $71.11 |
| West VirginiaWest Virginia | $491.60 | $76.53 |
| Wyoming**Wyoming | $551.64 | $74.01 |
19086 rates by state
Office rate range in each state. Select a state to see its payment localities.
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.
$481.51
$685.60
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $611.87 | 1 |
| AL | $489.61 | 1 |
| AR | $481.51 | 1 |
| AZ | $537.16 | 1 |
| CA | $598.37–$772.83 | 29 |
| CO | $583.84 | 1 |
| CT | $593.09 | 1 |
| DC | $643.87 | 1 |
| DE | $546.98 | 1 |
| FL | $534.49–$581.82 | 3 |
| GA | $501.47–$562.25 | 2 |
| GU | $617.63 | 1 |
| HI | $617.63 | 1 |
| IA | $508.19 | 1 |
| ID | $511.06 | 1 |
| IL | $513.83–$571.10 | 4 |
| IN | $514.55 | 1 |
| KS | $503.42 | 1 |
| KY | $498.43 | 1 |
| LA | $496.72–$525.08 | 2 |
| MA | $578.79–$649.65 | 2 |
| MD | $559.10–$643.87 | 3 |
| ME | $511.91–$546.63 | 2 |
| MI | $511.37–$539.92 | 2 |
| MN | $563.28 | 1 |
| MO | $485.58–$529.69 | 3 |
| MS | $483.76 | 1 |
| MT | $553.11 | 1 |
| NC | $518.35 | 1 |
| ND | $549.75 | 1 |
| NE | $511.99 | 1 |
| NH | $572.43 | 1 |
| NJ | $600.96–$635.36 | 2 |
| NM | $513.73 | 1 |
| NV | $552.66 | 1 |
| NY | $527.02–$654.06 | 5 |
| OH | $510.68 | 1 |
| OK | $499.60 | 1 |
| OR | $549.48–$606.81 | 2 |
| PA | $512.76–$575.30 | 2 |
| PR | $558.41 | 1 |
| RI | $569.74 | 1 |
| SC | $515.15 | 1 |
| SD | $549.35 | 1 |
| TN | $506.05 | 1 |
| TX | $508.77–$580.91 | 8 |
| UT | $523.24 | 1 |
| VA | $543.15–$643.87 | 2 |
| VI | $558.41 | 1 |
| VT | $545.43 | 1 |
| WA | $578.41–$665.88 | 2 |
| WI | $528.68 | 1 |
| WV | $491.60 | 1 |
| WY | $551.64 | 1 |
How the 19086 rate is calculated
Each of 19086’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 · 19086
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.77Practice expense 14.62Malpractice 0.17
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
The exact Delaware inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
1,664
- Code
- 19086
- Physician work
- 1.77
- Practice expense
- 14.62
- Malpractice
- 0.17
GPCI2026.csv
40
- Locality
- Delaware
- Physician work
- 1.005
- Practice expense
- 0.988
- Malpractice
- 0.899
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.77 | × 1.005 | 1.7788 |
| Practice expense | 14.62 | × 0.988 | 14.4446 |
| Malpractice | 0.17 | × 0.899 | 0.1528 |
| Total RVUs | 16.3762 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Delaware$546.98
Office: (1.77 × 1.005 + 14.62 × 0.988 + 0.17 × 0.899) × $33.4009 = $546.98
Facility: (1.77 × 1.005 + 0.32 × 0.988 + 0.17 × 0.899) × $33.4009 = $75.08
Payment rules and modifiers for 19086
The CMS indicators that decide how 19086 is paid alongside other services.
CMS payment indicators · 19086
Breast biopsy
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
How 19086 has changed in Delaware
19086 · Office / nonfacility
$546.98
Effective 2026-10-01
The base rate is $2.96 higher than on 2025-10-01, moving from $544.02 to $546.98 (0.5%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
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
January 1, 2026
RVU26A
$544.02changed to$546.98
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 1.82 changed to 1.77
- Practice expense RVU 14.95 changed to 14.62
- Malpractice RVU 0.16 changed to 0.17
- Work GPCI 1.009 changed to 1.005
- Practice expense GPCI 0.992 changed to 0.988
- Malpractice GPCI 0.949 changed to 0.899
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
Earliest loaded release: $544.02
Held through RVU25B, RVU25C, RVU25D.
Where the Delaware rate applies
Delaware is a Medicare payment area, not a city. Our Census mapping connects it to 79 cities and communities in Delaware. Some span more than one payment area; confirm with the service ZIP.
19086 billing questions
When is this code reported instead of 19085?
Use 19085 for the first lesion sampled with MRI guidance. Report 19086 for each additional lesion sampled with MRI guidance during the procedure.
Can 19086 be billed by itself?
No. It is an add-on code and must be reported with the primary MRI-guided breast biopsy code, 19085.
How many units should be reported?
Report one unit for each additional lesion sampled. The first lesion is represented by 19085, not by an additional unit of 19086.
Is marker placement separately reported?
Marker placement at the biopsy site, when performed, is part of the MRI-guided biopsy service. Specimen imaging, when performed, is also included in the service.
How does 19086 differ from 19084?
Both represent sampling of an additional lesion, but 19086 is for MRI guidance and 19084 is for ultrasound guidance.
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
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