$440.57
Both cover percutaneous biopsy of the first breast lesion, but 19083 uses ultrasound guidance and 19085 uses MRI guidance.
On this page
CMS RVU26D · Effective 2026-10-01
19085 Breast biopsy Medicare reimbursement rates in Idaho
Reports percutaneous tissue sampling of a breast lesion targeted with MRI, for the first lesion biopsied using MRI guidance. Compare 19085 office and facility rates across CMS payment localities in Idaho.
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.
What does Medicare pay for 19085 in Idaho?
Idaho has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$665.54
1 of 1 localities have a supported rate.
Payment area: Idaho
One mapped payment locality.
Facility setting
$143.46
1 of 1 localities have a supported rate.
Payment area: Idaho
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Breast imaging procedure
About 19085: MRI-guided percutaneous breast biopsy
Reports percutaneous tissue sampling of a breast lesion targeted with MRI, for the first lesion biopsied using MRI guidance.
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.
CMS billing rules for 19085
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is 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
- Assistant at surgery is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU3.55 · 16%
- Practice expense (office) RVU17.62 · 82%
- Malpractice RVU0.35 · 2%
7.9K
Medicare services in 2024 · #1598 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.
19085 compared with similar codes
Office rates for Idaho, from the same CMS release.
$443.39
Use 19081 when stereotactic imaging guides the first lesion biopsy; use 19085 when MRI provides the guidance.
$511.06
19085 reports the first MRI-guided lesion. 19086 reports each additional lesion sampled with MRI guidance.
Compare 19085 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Idaho →
Office / nonfacility
$665.54
Facility
$143.46
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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 19085 in Idaho.
PPRRVU2026_Oct_nonQPP.csv
1,663
- Code
- 19085
- Physician work
- 3.55
- Practice expense
- 17.62
- Malpractice
- 0.35
GPCI2026.csv
47
- Locality
- Idaho
- Physician work
- 1.000
- Practice expense
- 0.920
- Malpractice
- 0.473
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.55 | × 1.000 | 3.5500 |
| Practice expense | 17.62 | × 0.920 | 16.2104 |
| Malpractice | 0.35 | × 0.473 | 0.1655 |
| Total RVUs | 19.9260 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Idaho$665.54
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.55 | 1 |
| Practice expense | 17.62 | 0.92 |
| Malpractice | 0.35 | 0.473 |
(3.55 × 1 + 17.62 × 0.92 + 0.35 × 0.473) × $33.4009 = $665.54
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.55 | 1 |
| Practice expense | 0.63 | 0.92 |
| Malpractice | 0.35 | 0.473 |
(3.55 × 1 + 0.63 × 0.92 + 0.35 × 0.473) × $33.4009 = $143.46
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.
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 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.
1,66019082,,Bx breast add lesion strtctc,A,,1.61,9.10,,0.30,,0.17,10.88,2.08,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,66119083,,Bx breast 1st lesion us imag,A,,3.02,10.88,,0.55,,0.34,14.24,3.91,0,000,0.00,0.00,0.00,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,66219084,,Bx breast add lesion us imag,A,,1.51,9.03,,0.28,,0.16,10.70,1.95,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,66319085,,Bx breast 1st lesion mr imag,A,,3.55,17.62,,0.63,,0.35,21.52,4.53,0,000,0.00,0.00,0.00,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,66419086,,Bx breast add lesion mr imag,A,,1.77,14.62,,0.32,,0.17,16.56,2.26,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,66519100,,Bx breast percut w/o image,A,,1.24,3.35,,0.31,,0.30,4.89,1.85,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,66619101,,Biopsy of breast open,A,,3.15,6.55,,2.54,,0.79,10.49,6.48,0,010,0.10,0.80,0.10,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4410212,GA,01,ATLANTA,1.003,1.016,1.201
4510212,GA,99,REST OF GEORGIA,1.000,0.892,1.192
4601212,HI,01,"HAWAII, GUAM",1.000,1.137,0.579
4702202,ID,00,IDAHO,1.000,0.920,0.473
4806102,IL,16,CHICAGO,1.007,1.005,2.295
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772