CPT code 19085: Breast biopsy2026 Medicare rate & RVUs in Cutler, California
CPT 19085 pays $771.88 in the office and $149.92 in a facility in Cutler, CA under the 2026 Medicare fee schedule, 7% above the national rate. Locality math, rate history and payer benchmarks.
Medicare pays $771.88 for 19085 in the office in Cutler, California (Visalia). Which amount applies depends on the service address.
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 6 sections
19085 in Visalia
Cutler, California maps to 1 Medicare payment locality in our Census-to-CMS crosswalk. A city name alone doesn’t confirm an address’s payment area.
| Payment locality | Office | Facility |
|---|---|---|
| Visalia | $771.88 | $149.92 |
How payment areas work in Cutler
City limits and Medicare payment areas are different maps. These are the payment areas that cover the city’s counties; the service ZIP decides which one applies.
- Tulare · Tulare County
City boundaries: 2026 Census geography · Census source · CMS county-to-locality definitions
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.
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).
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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