Billing code 19081: Breast biopsyMedicare rate & RVUs in Colorado
Percutaneous stereotactic biopsy obtains breast tissue from a mammographic target, such as suspicious calcifications, when stereotactic guidance is used for the first lesion.
Medicare pays $500.03 for 19081 in the office in Colorado (Colorado). 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 9 sections
What 19081 covers
A radiologist typically performs this percutaneous breast biopsy by using mammographic stereotactic targeting to guide a needle into an abnormality and collect tissue samples. Common targets include suspicious calcifications or another mammographic finding that is not well seen with ultrasound. Marker placement and specimen imaging, when performed, are part of the service. The code covers the first lesion biopsied with stereotactic guidance during the session; a distinct additional lesion may be reported with 19082.
Select this code when stereotactic imaging guides the biopsy, rather than ultrasound or MRI. The report should identify the target and guidance method and document tissue sampling; include details of marker placement or specimen imaging when performed. The procedure has a 0-day global period, so same-day preoperative and postoperative care is included. For multiple procedures in one session, CMS pays the highest-valued procedure in full and reduces other procedures to 50%. Modifier 50 for bilateral performance 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.
19081 in Colorado
| Payment locality | Office | Facility |
|---|---|---|
| Colorado | $500.03 | $138.25 |
How the 19081 rate is calculated
Each of 19081’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 · 19081
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 3.21Practice expense 10.76Malpractice 0.35
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 19081
The CMS indicators that decide how 19081 is paid alongside other services.
CMS payment indicators · 19081
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
19081 without 50 · national office
$478.30
Breast biopsy
19081-50 · Bilateral: 150%
$717.45
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).
19081 compared with similar codes
Compare codes
19081 vs 19082 vs 19083 vs 19085: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 19082Breast biopsy
- 19081 represents the first stereotactically biopsied lesion in the session. Use 19082 for each distinct additional stereotactic lesion.
- 19083Breast biopsy
- Both cover biopsy of a first breast lesion, but 19083 is selected when ultrasound provides the guidance instead of stereotactic imaging.
- 19085Breast biopsy
- Use 19085 when MRI guides the first-lesion biopsy; 19081 is for stereotactic guidance.
19081 billing questions
When should 19081 be selected instead of 19083?
Report 19081 when stereotactic imaging guides the biopsy. Use 19083 when ultrasound guides the first-lesion biopsy.
How is a second stereotactic lesion reported?
Report 19082 for a distinct additional lesion biopsied with stereotactic guidance during the session. The first stereotactic lesion is reported with 19081.
Are marker placement and specimen imaging separately reported?
They are included in the service when performed. The biopsy documentation should indicate whether a marker was placed or specimen imaging was obtained.
Can modifier 50 be used for bilateral biopsies?
CMS identifies this as a bilateral procedure; modifier 50 is paid at 150%. Document the bilateral work performed.
What same-day care is included in the global period?
The 0-day global period includes same-day preoperative and postoperative care for the biopsy.
When is an assistant at surgery payable?
CMS pays an assistant at surgery only when medical necessity is documented. Co-surgeons and team surgery are not permitted.
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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