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CMS RVU26D · Effective 2026-10-01

19101 in El Centro

Office / nonfacility

$361.06

Base rate per service

Facility setting

$214.26

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 19101: Open incisional breast biopsy

Reports surgical sampling of breast tissue through an incision when an open incisional biopsy is performed rather than percutaneous sampling or lesion removal.

A surgeon makes an incision in the breast and removes a tissue sample for diagnostic examination. This approach may be selected when a breast mass or other suspicious area needs tissue diagnosis and an open sample is performed instead of a percutaneous biopsy. The service is commonly performed by a breast surgeon or general surgeon in an operating room or other surgical setting, with the specimen sent for pathology examination.

Report this code for open incisional sampling, not when the procedure removes the breast lesion as a whole. The operative note should identify the breast and site, describe the open sampling approach, and document the tissue obtained. Related postoperative visits during the 10-day global period are included. For multiple procedures in one session, Medicare pays the highest-valued procedure in full and other procedures at 50%. For bilateral reporting with modifier 50, payment is 150%. Medicare does not pay an assistant at surgery for this service; co-surgeons and team surgery are not permitted.

CMS billing rules for 19101

Global period
Minor procedure with a 10-day global period: related postoperative visits for 10 days 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
Statutory restriction: assistant at surgery is not paid.
Co-surgeons
Co-surgeons not permitted.
Team surgery
Team surgery not permitted.

Where the value comes from

  • Work RVU3.15 · 30%
  • Practice expense (office) RVU6.55 · 62%
  • Malpractice RVU0.79 · 8%

751

Medicare services in 2024 · #3208 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.

19101 compared with similar codes

Office rates for El Centro, from the same CMS release.

19100

Breast biopsy

Without imaging guidance

$170.18

19100 describes percutaneous breast sampling without imaging guidance. Choose 19101 when the surgeon obtains the sample through an incision.

19083

Breast biopsy

First lesion, ultrasound-guided

$507.02

19083 is a percutaneous biopsy performed with ultrasound guidance and includes localization-device placement when performed; 19101 is an open incisional biopsy.

19120

Breast lesion excision

Without marker localization

$586.08

19120 is for removal of a breast lesion. Use 19101 when the operative service is incisional sampling rather than removal of the lesion.

19125

Breast lesion excision

Single marker-localized lesion

$647.56

19125 describes excision of a breast lesion identified by preoperative radiological localization. It is not the open incisional sampling represented by 19101.

The same code, a different location

How does El Centro compare?

In Bakersfield, the office rate for 19101 is $363.06—$2.00 higher than the $361.06 rate in El Centro. Both use the same code, release and participation basis.

19101 across payment areas

Same release and payment basis · bars start at $0

  1. El Centro · This locality

    $361.06

  2. Bakersfield

    $363.06

    $2.00 higher than El Centro

  3. Chico

    $360.92

    $0.14 lower than El Centro

  4. Fresno

    $360.92

    $0.14 lower than El Centro

  5. Hanford-Corcoran

    $360.92

    $0.14 lower than El Centro

  6. Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty)

    $385.86

    $24.80 higher than El Centro

  7. Madera

    $360.92

    $0.14 lower than El Centro

Other payment areas listed in California 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, 19101 ranges from $306.73 in Arkansas to $446.40 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

  • Merced

    California · 19101

    Office

    $360.92

    Facility

    $214.13

    $0.14 lower than El Centro for the office setting.

  • Modesto

    California · 19101

    Office

    $360.92

    Facility

    $214.13

    $0.14 lower than El Centro for the office setting.

  • Napa

    California · 19101

    Office

    $413.59

    Facility

    $237.06

    $52.53 higher than El Centro for the office setting.

  • Oxnard-Thousand Oaks-Ventura

    California · 19101

    Office

    $383.19

    Facility

    $224.88

    $22.13 higher than El Centro for the office setting.

  • Redding

    California · 19101

    Office

    $360.92

    Facility

    $214.13

    $0.14 lower than El Centro for the office setting.

  • Rest Of California

    California · 19101

    Office

    $360.92

    Facility

    $214.13

    $0.14 lower than El Centro for the office setting.

  • Riverside-San Bernardino-Ontario

    California · 19101

    Office

    $369.39

    Facility

    $222.60

    $8.33 higher than El Centro for the office setting.

  • Sacramento-Roseville-Folsom

    California · 19101

    Office

    $377.58

    Facility

    $221.81

    $16.52 higher than El Centro for the office setting.

  • Salinas

    California · 19101

    Office

    $376.18

    Facility

    $220.95

    $15.12 higher than El Centro for the office setting.

  • San Diego-Chula Vista-Carlsbad

    California · 19101

    Office

    $384.33

    Facility

    $224.14

    $23.27 higher than El Centro for the office setting.

  • San Francisco-Oakland-Berkeley (Marin Cnty)

    California · 19101

    Office

    $435.79

    Facility

    $246.94

    $74.73 higher than El Centro for the office setting.

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

    California · 19101

    Office

    $434.90

    Facility

    $246.04

    $73.84 higher than El Centro for the office setting.

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

    California · 19101

    Office

    $446.40

    Facility

    $253.27

    $85.34 higher than El Centro for the office setting.

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

    California · 19101

    Office

    $442.74

    Facility

    $249.60

    $81.68 higher than El Centro for the office setting.

  • San Luis Obispo-Paso Robles

    California · 19101

    Office

    $370.33

    Facility

    $217.78

    $9.27 higher than El Centro for the office setting.

  • Santa Cruz-Watsonville

    California · 19101

    Office

    $387.38

    Facility

    $224.64

    $26.32 higher than El Centro for the office setting.

  • Santa Maria-Santa Barbara

    California · 19101

    Office

    $377.39

    Facility

    $221.22

    $16.33 higher than El Centro for the office setting.

  • Santa Rosa-Petaluma

    California · 19101

    Office

    $391.17

    Facility

    $226.69

    $30.11 higher than El Centro for the office setting.

  • Stockton

    California · 19101

    Office

    $360.92

    Facility

    $214.13

    $0.14 lower than El Centro for the office setting.

  • Vallejo

    California · 19101

    Office

    $412.30

    Facility

    $235.77

    $51.24 higher than El Centro for the office setting.

  • Visalia

    California · 19101

    Office

    $360.92

    Facility

    $214.13

    $0.14 lower than El Centro for the office setting.

  • Yuba City

    California · 19101

    Office

    $360.92

    Facility

    $214.13

    $0.14 lower than El Centro for the office setting.

  • Dc + Md/Va Suburbs

    District of Columbia · 19101

    Office

    $397.98

    Facility

    $240.20

    $36.92 higher than El Centro for the office setting.

  • Miami

    Florida · 19101

    Office

    $399.69

    Facility

    $260.26

    $38.63 higher than El Centro for the office setting.

  • Chicago

    Illinois · 19101

    Office

    $386.38

    Facility

    $251.77

    $25.32 higher than El Centro for the office setting.

  • Manhattan

    New York · 19101

    Office

    $408.01

    Facility

    $252.38

    $46.95 higher than El Centro for the office setting.

  • Alaska*

    Alaska · 19101

    Office

    $405.35

    Facility

    $262.71

    $44.29 higher than El Centro for the office setting.

  • Alabama

    Alabama · 19101

    Office

    $311.58

    Facility

    $194.38

    $49.48 lower than El Centro for the office setting.

  • Arkansas

    Arkansas · 19101

    Office

    $306.73

    Facility

    $191.68

    $54.33 lower than El Centro for the office setting.

  • Arizona

    Arizona · 19101

    Office

    $339.79

    Facility

    $210.01

    $21.27 lower than El Centro for the office setting.

  • Colorado

    Colorado · 19101

    Office

    $359.86

    Facility

    $217.35

    $1.20 lower than El Centro for the office setting.

  • Connecticut

    Connecticut · 19101

    Office

    $374.87

    Facility

    $230.62

    $13.81 higher than El Centro for the office setting.

  • Delaware

    Delaware · 19101

    Office

    $345.61

    Facility

    $213.28

    $15.45 lower than El Centro for the office setting.

  • Fort Lauderdale

    Florida · 19101

    Office

    $374.54

    Facility

    $238.86

    $13.48 higher than El Centro for the office setting.

  • Rest Of Florida

    Florida · 19101

    Office

    $354.02

    Facility

    $225.98

    $7.04 lower than El Centro for the office setting.

  • Atlanta

    Georgia · 19101

    Office

    $359.50

    Facility

    $223.41

    $1.56 lower than El Centro for the office setting.

  • Rest Of Georgia

    Georgia · 19101

    Office

    $331.81

    Facility

    $212.34

    $29.25 lower than El Centro for the office setting.

  • Hawaii, Guam

    Hawaii · 19101

    Office

    $369.24

    Facility

    $216.95

    $8.18 higher than El Centro for the office setting.

  • Iowa

    Iowa · 19101

    Office

    $315.87

    Facility

    $193.32

    $45.19 lower than El Centro for the office setting.

  • Idaho

    Idaho · 19101

    Office

    $318.97

    Facility

    $195.74

    $42.09 lower than El Centro for the office setting.

  • East St. Louis

    Illinois · 19101

    Office

    $359.63

    Facility

    $236.41

    $1.43 lower than El Centro for the office setting.

  • Rest Of Illinois

    Illinois · 19101

    Office

    $346.20

    Facility

    $223.91

    $14.86 lower than El Centro for the office setting.

  • Suburban Chicago

    Illinois · 19101

    Office

    $377.39

    Facility

    $239.84

    $16.33 higher than El Centro for the office setting.

  • Indiana

    Indiana · 19101

    Office

    $320.84

    Facility

    $196.68

    $40.22 lower than El Centro for the office setting.

  • Kansas

    Kansas · 19101

    Office

    $316.29

    Facility

    $195.21

    $44.77 lower than El Centro for the office setting.

  • Kentucky

    Kentucky · 19101

    Office

    $323.85

    Facility

    $204.78

    $37.21 lower than El Centro for the office setting.

  • New Orleans

    Louisiana · 19101

    Office

    $341.06

    Facility

    $215.02

    $20.00 lower than El Centro for the office setting.

  • Rest Of Louisiana

    Louisiana · 19101

    Office

    $324.11

    Facility

    $205.57

    $36.95 lower than El Centro for the office setting.

  • Metropolitan Boston

    Massachusetts · 19101

    Office

    $394.23

    Facility

    $234.31

    $33.17 higher than El Centro for the office setting.

  • Rest Of Massachusetts

    Massachusetts · 19101

    Office

    $358.30

    Facility

    $217.26

    $2.76 lower than El Centro for the office setting.

  • Baltimore/Surr. Cntys

    Maryland · 19101

    Office

    $374.28

    Facility

    $230.57

    $13.22 higher than El Centro for the office setting.

  • Rest Of Maryland

    Maryland · 19101

    Office

    $351.89

    Facility

    $216.34

    $9.17 lower than El Centro for the office setting.

  • Rest Of Maine

    Maine · 19101

    Office

    $322.90

    Facility

    $199.68

    $38.16 lower than El Centro for the office setting.

  • Southern Maine

    Maine · 19101

    Office

    $338.67

    Facility

    $205.94

    $22.39 lower than El Centro for the office setting.

  • Detroit

    Michigan · 19101

    Office

    $360.82

    Facility

    $231.57

    $0.24 lower than El Centro for the office setting.

  • Rest Of Michigan

    Michigan · 19101

    Office

    $334.75

    Facility

    $212.46

    $26.31 lower than El Centro for the office setting.

  • Minnesota

    Minnesota · 19101

    Office

    $338.14

    Facility

    $200.32

    $22.92 lower than El Centro for the office setting.

  • Metropolitan Kansas City

    Missouri · 19101

    Office

    $336.42

    Facility

    $210.66

    $24.64 lower than El Centro for the office setting.

  • Metropolitan St. Louis

    Missouri · 19101

    Office

    $339.93

    Facility

    $212.42

    $21.13 lower than El Centro for the office setting.

  • Rest Of Missouri

    Missouri · 19101

    Office

    $319.50

    Facility

    $204.04

    $41.56 lower than El Centro for the office setting.

  • Mississippi

    Mississippi · 19101

    Office

    $313.08

    Facility

    $197.76

    $47.98 lower than El Centro for the office setting.

  • Montana**

    Montana · 19101

    Office

    $350.32

    Facility

    $216.39

    $10.74 lower than El Centro for the office setting.

  • North Carolina

    North Carolina · 19101

    Office

    $326.19

    Facility

    $201.23

    $34.87 lower than El Centro for the office setting.

  • North Dakota**

    North Dakota · 19101

    Office

    $334.70

    Facility

    $200.76

    $26.36 lower than El Centro for the office setting.

  • Nebraska

    Nebraska · 19101

    Office

    $317.12

    Facility

    $193.49

    $43.94 lower than El Centro for the office setting.

  • New Hampshire

    New Hampshire · 19101

    Office

    $356.05

    Facility

    $216.62

    $5.01 lower than El Centro for the office setting.

  • Northern Nj

    New Jersey · 19101

    Office

    $393.80

    Facility

    $238.43

    $32.74 higher than El Centro for the office setting.

  • Rest Of New Jersey

    New Jersey · 19101

    Office

    $377.27

    Facility

    $231.01

    $16.21 higher than El Centro for the office setting.

  • New Mexico

    New Mexico · 19101

    Office

    $337.52

    Facility

    $214.70

    $23.54 lower than El Centro for the office setting.

  • Nevada**

    Nevada · 19101

    Office

    $346.19

    Facility

    $212.12

    $14.87 lower than El Centro for the office setting.

  • Nyc Suburbs/Long Island

    New York · 19101

    Office

    $421.07

    Facility

    $261.82

    $60.01 higher than El Centro for the office setting.

  • Poughkpsie/N Nyc Suburbs

    New York · 19101

    Office

    $381.43

    Facility

    $234.77

    $20.37 higher than El Centro for the office setting.

  • Queens

    New York · 19101

    Office

    $408.59

    Facility

    $250.27

    $47.53 higher than El Centro for the office setting.

  • Rest Of New York

    New York · 19101

    Office

    $331.60

    Facility

    $204.36

    $29.46 lower than El Centro for the office setting.

  • Ohio

    Ohio · 19101

    Office

    $331.55

    Facility

    $209.27

    $29.51 lower than El Centro for the office setting.

  • Oklahoma

    Oklahoma · 19101

    Office

    $321.08

    Facility

    $201.48

    $39.98 lower than El Centro for the office setting.

  • Portland

    Oregon · 19101

    Office

    $369.59

    Facility

    $220.78

    $8.53 higher than El Centro for the office setting.

  • Rest Of Oregon

    Oregon · 19101

    Office

    $341.66

    Facility

    $208.26

    $19.40 lower than El Centro for the office setting.

  • Metropolitan Philadelphia

    Pennsylvania · 19101

    Office

    $366.33

    Facility

    $226.90

    $5.27 higher than El Centro for the office setting.

  • Rest Of Pennsylvania

    Pennsylvania · 19101

    Office

    $330.98

    Facility

    $208.03

    $30.08 lower than El Centro for the office setting.

  • Puerto Rico

    Puerto Rico · 19101

    Office

    $352.39

    Facility

    $216.98

    $8.67 lower than El Centro for the office setting.

  • Rhode Island

    Rhode Island · 19101

    Office

    $356.74

    Facility

    $218.39

    $4.32 lower than El Centro for the office setting.

  • South Carolina

    South Carolina · 19101

    Office

    $329.79

    Facility

    $206.03

    $31.27 lower than El Centro for the office setting.

  • South Dakota**

    South Dakota · 19101

    Office

    $332.85

    Facility

    $198.92

    $28.21 lower than El Centro for the office setting.

  • Tennessee

    Tennessee · 19101

    Office

    $318.25

    Facility

    $196.50

    $42.81 lower than El Centro for the office setting.

  • Austin

    Texas · 19101

    Office

    $360.27

    Facility

    $218.56

    $0.79 lower than El Centro for the office setting.

  • Beaumont

    Texas · 19101

    Office

    $328.81

    Facility

    $206.93

    $32.25 lower than El Centro for the office setting.

  • Brazoria

    Texas · 19101

    Office

    $343.44

    Facility

    $210.71

    $17.62 lower than El Centro for the office setting.

  • Dallas

    Texas · 19101

    Office

    $346.70

    Facility

    $213.30

    $14.36 lower than El Centro for the office setting.

  • Fort Worth

    Texas · 19101

    Office

    $344.86

    Facility

    $212.79

    $16.20 lower than El Centro for the office setting.

  • Galveston

    Texas · 19101

    Office

    $345.15

    Facility

    $212.15

    $15.91 lower than El Centro for the office setting.

  • Houston

    Texas · 19101

    Office

    $359.61

    Facility

    $226.61

    $1.45 lower than El Centro for the office setting.

  • Rest Of Texas

    Texas · 19101

    Office

    $336.66

    Facility

    $209.55

    $24.40 lower than El Centro for the office setting.

  • Utah

    Utah · 19101

    Office

    $334.56

    Facility

    $208.66

    $26.50 lower than El Centro for the office setting.

  • Virginia

    Virginia · 19101

    Office

    $338.90

    Facility

    $207.24

    $22.16 lower than El Centro for the office setting.

  • Virgin Islands

    United States Virgin Islands · 19101

    Office

    $352.39

    Facility

    $216.98

    $8.67 lower than El Centro for the office setting.

  • Vermont

    Vermont · 19101

    Office

    $335.15

    Facility

    $202.55

    $25.91 lower than El Centro for the office setting.

  • Rest Of Washington

    Washington · 19101

    Office

    $357.03

    Facility

    $216.00

    $4.03 lower than El Centro for the office setting.

  • Seattle (King Cnty)

    Washington · 19101

    Office

    $400.47

    Facility

    $236.13

    $39.41 higher than El Centro for the office setting.

  • Wisconsin

    Wisconsin · 19101

    Office

    $322.93

    Facility

    $194.62

    $38.13 lower than El Centro for the office setting.

  • West Virginia

    West Virginia · 19101

    Office

    $333.09

    Facility

    $216.70

    $27.97 lower than El Centro for the office setting.

  • Wyoming**

    Wyoming · 19101

    Office

    $343.51

    Facility

    $209.58

    $17.55 lower than El Centro for the office setting.

See how rates vary across the country

19101 · 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.

$306.73

$405.35

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

View all state and territory rates as a table
State / territoryRate rangeLocalities
AK$405.351
AL$311.581
AR$306.731
AZ$339.791
CA$360.92–$446.4029
CO$359.861
CT$374.871
DC$397.981
DE$345.611
FL$354.02–$399.693
GA$331.81–$359.502
GU$369.241
HI$369.241
IA$315.871
ID$318.971
IL$346.20–$386.384
IN$320.841
KS$316.291
KY$323.851
LA$324.11–$341.062
MA$358.30–$394.232
MD$351.89–$397.983
ME$322.90–$338.672
MI$334.75–$360.822
MN$338.141
MO$319.50–$339.933
MS$313.081
MT$350.321
NC$326.191
ND$334.701
NE$317.121
NH$356.051
NJ$377.27–$393.802
NM$337.521
NV$346.191
NY$331.60–$421.075
OH$331.551
OK$321.081
OR$341.66–$369.592
PA$330.98–$366.332
PR$352.391
RI$356.741
SC$329.791
SD$332.851
TN$318.251
TX$328.81–$360.278
UT$334.561
VA$338.90–$397.982
VI$352.391
VT$335.151
WA$357.03–$400.472
WI$322.931
WV$333.091
WY$343.511

Explore 19101 on the national rate map →

Where does this rate apply?

El Centro is a Medicare payment area. Our Census mapping connects it to 18 cities and communities in California, 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 California →

Why are the office and facility amounts different?

For 19101 in El Centro, the physician’s office rate is $361.06 and the facility-setting rate is $214.26: a difference of $146.80.

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 19101 in El Centro. This uses the base rate on this page, so the locality and release stay consistent.

Reference amount per service

$397.17

$361.06 × 110% = $397.17

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 19101 in El Centro.

PPRRVU2026_Oct_nonQPP.csv

1,666

Code
19101
Physician work
3.15
Practice expense
6.55
Malpractice
0.79

GPCI2026.csv

10

Locality
El Centro
Physician work
1.017
Practice expense
1.096
Malpractice
0.541
Office / nonfacility calculation for 19101 in El Centro
ComponentRVULocality factorAdjusted
Physician work3.15× 1.0173.2035
Practice expense6.55× 1.0967.1788
Malpractice0.79× 0.5410.4274
Total RVUs10.8097
Conversion factor× 33.4009

Office / nonfacility rate, El Centro$361.06

Values as parsed from CMS release RVU26D, effective 2026-10-01. The amount is rounded to the nearest cent only at the end.

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Explore RVUs, geographic factors and the full formula

Office / nonfacility

Office / nonfacility calculation inputs
ComponentRVULocal GPCI
Work3.151.017
Practice expense6.551.096
Malpractice0.790.541

(3.15 × 1.017 + 6.55 × 1.096 + 0.79 × 0.541) × $33.4009 = $361.06

Facility

Facility calculation inputs
ComponentRVULocal GPCI
Work3.151.017
Practice expense2.541.096
Malpractice0.790.541

(3.15 × 1.017 + 2.54 × 1.096 + 0.79 × 0.541) × $33.4009 = $214.26

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

19101 · Office / nonfacility

$361.06

Effective 2026-10-01

The base rate is $43.80 higher than on 2025-10-01, moving from $317.26 to $361.06 (13.8%).

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

    $317.26changed to$361.06

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 3.23 changed to 3.15
    • Practice expense RVU 5.56 changed to 6.55
    • Malpractice RVU 0.80 changed to 0.79
    • Work GPCI 1.014 changed to 1.017
    • Practice expense GPCI 1.093 changed to 1.096
    • Malpractice GPCI 0.570 changed to 0.541

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    Earliest loaded release: $317.26

    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$361.06$214.26RVU26D
2026-07-01$361.06$214.26RVU26C
2026-04-01$361.06$214.26RVU26B
2026-01-01$361.06$214.26RVU26A
2025-10-01$317.26$218.27RVU25D
2025-07-01$317.26$218.27RVU25C
2025-04-01$317.26$218.27RVU25B
2025-01-01$317.26$218.27RVU25A

19101 billing questions

When should 19101 be chosen over 19100?

Use 19101 for an open incisional sample obtained through a surgical incision. Code 19100 describes percutaneous breast sampling without imaging guidance.

How does 19101 differ from excision of a breast lesion?

19101 represents sampling of tissue through an incision. When the procedure removes the lesion rather than taking an incisional sample, consider an excision code such as 19120.

Can pathology be reported separately?

The tissue specimen may be examined and reported by a pathologist using an appropriate surgical pathology code, such as 88305, when the pathology service is performed.

How is bilateral breast biopsy reported?

CMS lists this as a bilateral procedure; modifier 50 is paid at 150%. The documentation should support open incisional biopsy on both sides.

Is an assistant surgeon payable for 19101?

No. CMS identifies a statutory restriction on assistant-at-surgery payment for this code. Co-surgeons and team surgery are also not permitted.

What postoperative care is included?

Related postoperative visits during the 10-day global period are included in the procedure.

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 19101PPRRVU2026_Oct_nonQPP.csv, line 1,666 (RVU26D)
Geographic factors for El CentroGPCI2026.csv, line 10 (RVU26D)
Open CMS sourceHow this rate is calculatedBuild a fee sheet