Billing code 19085: Breast biopsyMedicare rate & RVUs in Manhattan
Reports percutaneous tissue sampling of a breast lesion targeted with MRI, for the first lesion biopsied using MRI guidance.
In Manhattan, Medicare pays $828.57 for 19085 in the office and $169.15 when it’s performed in a hospital or facility.
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.
On this page 11 sections
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 Manhattan 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). Manhattan pays $828.57. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Manhattan · this page$828.57
- Nyc Suburbs/Long Island · New York$847.63+$19.06
- Poughkpsie/N Nyc Suburbs · New York$782.49−$46.08
- Queens · New York$838.65+$10.08
- Rest Of New York · New York$685.89−$142.68
- Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) · California$827.42−$1.15
- Dc + Md/Va Suburbs · District of Columbia$831.27+$2.70
Other areas in New York first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| MiamiFlorida | $760.79 | $170.04 |
| ChicagoIllinois | $737.70 | $167.38 |
| 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 |
| FresnoCalifornia | $771.88 | $149.92 |
| Hanford-CorcoranCalifornia | $771.88 | $149.92 |
| MaderaCalifornia | $771.88 | $149.92 |
| MercedCalifornia | $771.88 | $149.92 |
| ModestoCalifornia | $771.88 | $149.92 |
| NapaCalifornia | $907.66 | $159.72 |
| Oxnard-Thousand Oaks-VenturaCalifornia | $824.81 | $154.05 |
| ReddingCalifornia | $771.88 | $149.92 |
| Rest Of CaliforniaCalifornia | $771.88 | $149.92 |
| Riverside-San Bernardino-OntarioCalifornia | $775.70 | $153.74 |
| Sacramento-Roseville-FolsomCalifornia | $813.56 | $153.58 |
| SalinasCalifornia | $810.61 | $152.90 |
| San Diego-Chula Vista-CarlsbadCalifornia | $832.34 | $153.63 |
| San Francisco-Oakland-Berkeley (Marin Cnty)California | $965.02 | $164.87 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)California | $964.62 | $164.48 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty)California | $986.53 | $168.23 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)California | $984.91 | $166.60 |
| San Luis Obispo-Paso RoblesCalifornia | $797.18 | $150.82 |
| Santa Cruz-WatsonvilleCalifornia | $842.39 | $152.90 |
| Santa Maria-Santa BarbaraCalifornia | $814.38 | $152.69 |
| Santa Rosa-PetalumaCalifornia | $851.10 | $154.24 |
| StocktonCalifornia | $771.88 | $149.92 |
| VallejoCalifornia | $907.08 | $159.14 |
| VisaliaCalifornia | $771.88 | $149.92 |
| Yuba CityCalifornia | $771.88 | $149.92 |
| ColoradoColorado | $755.32 | $151.52 |
| ConnecticutConnecticut | $768.93 | $157.75 |
| DelawareDelaware | $711.14 | $150.47 |
| Fort LauderdaleFlorida | $735.88 | $161.03 |
| Rest Of FloridaFlorida | $698.77 | $156.26 |
| AtlantaGeorgia | $730.91 | $154.35 |
| Rest Of GeorgiaGeorgia | $657.47 | $151.28 |
| Hawaii, GuamHawaii | $794.49 | $149.27 |
| IowaIowa | $661.71 | $142.47 |
| IdahoIdaho | $665.54 | $143.46 |
| East St. LouisIllinois | $683.56 | $161.48 |
| Rest Of IllinoisIllinois | $674.17 | $156.06 |
| Suburban ChicagoIllinois | $744.53 | $161.73 |
| IndianaIndiana | $669.82 | $143.76 |
| KansasKansas | $656.49 | $143.49 |
| KentuckyKentucky | $652.47 | $147.98 |
| New OrleansLouisiana | $685.65 | $151.65 |
| Rest Of LouisianaLouisiana | $650.62 | $148.40 |
| Metropolitan BostonMassachusetts | $836.54 | $158.96 |
| Rest Of MassachusettsMassachusetts | $749.50 | $151.95 |
| Baltimore/Surr. CntysMaryland | $766.42 | $157.51 |
| Rest Of MarylandMaryland | $726.08 | $151.79 |
| Rest Of MaineMaine | $667.29 | $145.20 |
| Southern MaineMaine | $709.18 | $146.80 |
| DetroitMichigan | $706.21 | $158.59 |
| Rest Of MichiganMichigan | $669.09 | $150.98 |
| MinnesotaMinnesota | $727.62 | $143.69 |
| Metropolitan Kansas CityMissouri | $682.62 | $149.75 |
| Metropolitan St. LouisMissouri | $690.56 | $150.32 |
| Rest Of MissouriMissouri | $637.27 | $148.10 |
| MississippiMississippi | $633.93 | $145.33 |
| Montana**Montana | $718.76 | $151.28 |
| North CarolinaNorth Carolina | $675.14 | $145.68 |
| North Dakota**North Dakota | $711.84 | $144.36 |
| NebraskaNebraska | $666.20 | $142.41 |
| New HampshireNew Hampshire | $741.46 | $150.71 |
| Northern NjNew Jersey | $821.22 | $162.94 |
| Rest Of New JerseyNew Jersey | $778.81 | $159.12 |
| New MexicoNew Mexico | $672.29 | $151.91 |
| Nevada**Nevada | $717.42 | $149.37 |
| OhioOhio | $667.68 | $149.57 |
| OklahomaOklahoma | $653.21 | $146.45 |
| PortlandOregon | $783.02 | $152.55 |
| Rest Of OregonOregon | $712.96 | $147.75 |
| Metropolitan PhiladelphiaPennsylvania | $747.31 | $156.56 |
| Rest Of PennsylvaniaPennsylvania | $669.89 | $148.94 |
| Puerto RicoPuerto Rico | $725.09 | $151.36 |
| Rhode IslandRhode Island | $739.20 | $152.99 |
| South CarolinaSouth Carolina | $672.31 | $147.95 |
| South Dakota**South Dakota | $711.02 | $143.54 |
| TennesseeTennessee | $659.82 | $143.98 |
| AustinTexas | $751.83 | $151.43 |
| BeaumontTexas | $664.99 | $148.58 |
| BrazoriaTexas | $711.87 | $149.49 |
| DallasTexas | $715.84 | $150.63 |
| Fort WorthTexas | $710.11 | $150.57 |
| GalvestonTexas | $713.61 | $150.10 |
| HoustonTexas | $720.01 | $156.50 |
| Rest Of TexasTexas | $687.64 | $149.10 |
| UtahUtah | $682.28 | $148.85 |
| VirginiaVirginia | $705.35 | $147.51 |
| Virgin IslandsUnited States Virgin Islands | $725.09 | $151.36 |
| VermontVermont | $707.13 | $145.32 |
| Rest Of WashingtonWashington | $748.73 | $151.17 |
| Seattle (King Cnty)Washington | $856.17 | $159.87 |
| WisconsinWisconsin | $685.98 | $142.33 |
| West VirginiaWest Virginia | $646.73 | $153.59 |
| Wyoming**Wyoming | $715.75 | $148.27 |
19085 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.
$630.14
$879.20
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 | $811.08 | 1 |
| AL | $640.15 | 1 |
| AR | $630.14 | 1 |
| AZ | $698.86 | 1 |
| CA | $771.88–$986.53 | 29 |
| CO | $755.32 | 1 |
| CT | $768.93 | 1 |
| DC | $831.27 | 1 |
| DE | $711.14 | 1 |
| FL | $698.77–$760.79 | 3 |
| GA | $657.47–$730.91 | 2 |
| GU | $794.49 | 1 |
| HI | $794.49 | 1 |
| IA | $661.71 | 1 |
| ID | $665.54 | 1 |
| IL | $674.17–$744.53 | 4 |
| IN | $669.82 | 1 |
| KS | $656.49 | 1 |
| KY | $652.47 | 1 |
| LA | $650.62–$685.65 | 2 |
| MA | $749.50–$836.54 | 2 |
| MD | $726.08–$831.27 | 3 |
| ME | $667.29–$709.18 | 2 |
| MI | $669.09–$706.21 | 2 |
| MN | $727.62 | 1 |
| MO | $637.27–$690.56 | 3 |
| MS | $633.93 | 1 |
| MT | $718.76 | 1 |
| NC | $675.14 | 1 |
| ND | $711.84 | 1 |
| NE | $666.20 | 1 |
| NH | $741.46 | 1 |
| NJ | $778.81–$821.22 | 2 |
| NM | $672.29 | 1 |
| NV | $717.42 | 1 |
| NY | $685.89–$847.63 | 5 |
| OH | $667.68 | 1 |
| OK | $653.21 | 1 |
| OR | $712.96–$783.02 | 2 |
| PA | $669.89–$747.31 | 2 |
| PR | $725.09 | 1 |
| RI | $739.20 | 1 |
| SC | $672.31 | 1 |
| SD | $711.02 | 1 |
| TN | $659.82 | 1 |
| TX | $664.99–$751.83 | 8 |
| UT | $682.28 | 1 |
| VA | $705.35–$831.27 | 2 |
| VI | $725.09 | 1 |
| VT | $707.13 | 1 |
| WA | $748.73–$856.17 | 2 |
| WI | $685.98 | 1 |
| WV | $646.73 | 1 |
| WY | $715.75 | 1 |
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
Swap in your local Medicare rate.
Work 3.55Practice expense 17.62Malpractice 0.35
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
The exact Manhattan 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
78
- Locality
- Manhattan
- Physician work
- 1.064
- Practice expense
- 1.162
- Malpractice
- 1.586
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.55 | × 1.064 | 3.7772 |
| Practice expense | 17.62 | × 1.162 | 20.4744 |
| Malpractice | 0.35 | × 1.586 | 0.5551 |
| Total RVUs | 24.8067 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Manhattan$828.57
Office: (3.55 × 1.064 + 17.62 × 1.162 + 0.35 × 1.586) × $33.4009 = $828.57
Facility: (3.55 × 1.064 + 0.63 × 1.162 + 0.35 × 1.586) × $33.4009 = $169.15
Payment rules and modifiers for 19085
The CMS indicators that decide how 19085 is paid alongside other services.
CMS payment indicators · 19085
Breast biopsy
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| 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. |
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).
How 19085 has changed in Manhattan
19085 · Office / nonfacility
$828.57
Effective 2026-10-01
The base rate is $5.10 higher than on 2025-10-01, moving from $823.47 to $828.57 (0.6%).
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
$823.47changed to$828.57
- 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
- Work GPCI 1.065 changed to 1.064
- Practice expense GPCI 1.166 changed to 1.162
- Malpractice GPCI 1.656 changed to 1.586
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
Earliest loaded release: $823.47
Held through RVU25B, RVU25C, RVU25D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $828.57 | $169.15 | RVU26D |
| 2026-07-01 | $828.57 | $169.15 | RVU26C |
| 2026-04-01 | $828.57 | $169.15 | RVU26B |
| 2026-01-01 | $828.57 | $169.15 | RVU26A |
| 2025-10-01 | $823.47 | $193.23 | RVU25D |
| 2025-07-01 | $823.47 | $193.23 | RVU25C |
| 2025-04-01 | $823.47 | $193.23 | RVU25B |
| 2025-01-01 | $823.47 | $193.23 | RVU25A |
Where the Manhattan rate applies
Manhattan is a Medicare payment area, not a city. Our Census mapping connects it to 1 cities and communities in New York. Some span more than one payment area; confirm with the service ZIP.
- 19085 in New York · multiple payment areas
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
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