$149.10
19100 is percutaneous breast biopsy without imaging guidance. Choose 19110 for operative exploration of the nipple or ductal system, not needle sampling.
On this page
CMS RVU26D · Effective 2026-10-01
19110 Nipple exploration Medicare reimbursement rates in Idaho
Operative exploration of the nipple and lactiferous duct, often for pathologic nipple discharge, with possible removal of a solitary duct. Compare 19110 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 19110 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
$486.36
1 of 1 localities have a supported rate.
Payment area: Idaho
One mapped payment locality.
Facility setting
$321.96
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 surgery
About 19110: Nipple duct exploration
Operative exploration of the nipple and lactiferous duct, often for pathologic nipple discharge, with possible removal of a solitary duct.
This service involves surgically examining the nipple and its ductal system, commonly when pathologic nipple discharge prompts operative evaluation. The surgeon may remove a solitary duct during the exploration. Breast or general surgeons typically perform the procedure in an operating-room setting to identify or treat a duct-related source of discharge; it is distinct from removing a separate breast lesion.
Report 19110 when the operative work is nipple or duct exploration, rather than needle sampling or excision of a breast lesion. The operative note should support the discharge or other indication, the nipple and side treated, the exploration performed, and any duct removed. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment is restricted; co-surgeons and team surgery are not permitted.
CMS billing rules for 19110
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care 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 RVU4.33 · 27%
- Practice expense (office) RVU10.54 · 66%
- Malpractice RVU1.13 · 7%
335
Medicare services in 2024 · #3901 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.
19110 compared with similar codes
Office rates for Idaho, from the same CMS release.
$318.97
19101 describes open breast biopsy. Choose 19110 when the operative work is nipple-duct exploration rather than open tissue sampling.
$460.07
19112 is for excision of a breast duct fistula. 19110 concerns exploration of the nipple duct, commonly prompted by pathologic discharge.
$521.08
19120 describes removal of a breast lesion. 19110 is selected for nipple or duct exploration, not excision of a separate breast lesion.
Compare 19110 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
$486.36
Facility
$321.96
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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 19110 in Idaho.
PPRRVU2026_Oct_nonQPP.csv
1,668
- Code
- 19110
- Physician work
- 4.33
- Practice expense
- 10.54
- Malpractice
- 1.13
GPCI2026.csv
47
- Locality
- Idaho
- Physician work
- 1.000
- Practice expense
- 0.920
- Malpractice
- 0.473
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 4.33 | × 1.000 | 4.3300 |
| Practice expense | 10.54 | × 0.920 | 9.6968 |
| Malpractice | 1.13 | × 0.473 | 0.5345 |
| Total RVUs | 14.5613 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Idaho$486.36
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 4.33 | 1 |
| Practice expense | 10.54 | 0.92 |
| Malpractice | 1.13 | 0.473 |
(4.33 × 1 + 10.54 × 0.92 + 1.13 × 0.473) × $33.4009 = $486.36
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 4.33 | 1 |
| Practice expense | 5.19 | 0.92 |
| Malpractice | 1.13 | 0.473 |
(4.33 × 1 + 5.19 × 0.92 + 1.13 × 0.473) × $33.4009 = $321.96
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.
19110 billing questions
When is 19110 preferable to a breast biopsy code?
Use 19110 when the surgeon operates to explore the nipple or ductal system, commonly for pathologic discharge. A breast biopsy code describes sampling breast tissue rather than nipple-duct exploration.
Can a solitary duct be removed during this service?
Yes. Removal of a solitary duct may be part of the nipple exploration; document the ductal work performed.
How should bilateral exploration be reported?
CMS lists modifier 50 for bilateral reporting, with payment at 150%. Document the procedure on both sides.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be paid?
CMS applies a statutory restriction on assistant-at-surgery payment for this code. Co-surgeons and team surgery are not permitted.
How are other procedures in the same session paid?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%.
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.
1,66519100,,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
1,66719105,,Cryosurg ablate fa each,A,,3.60,71.34,,1.22,,0.98,75.92,5.80,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,66819110,,Nipple exploration,A,,4.33,10.54,,5.19,,1.13,16.00,10.65,0,090,0.10,0.71,0.19,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,66919112,,Excise breast duct fistula,A,,3.71,10.42,,5.19,,1.01,15.14,9.91,0,090,0.10,0.71,0.19,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,67019120,,Removal of breast lesion,A,,5.77,9.94,,4.99,,1.45,17.16,12.21,0,090,0.10,0.71,0.19,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,67119125,,Excision breast lesion,A,,6.52,10.81,,5.35,,1.68,19.01,13.55,0,090,0.10,0.71,0.19,2,1,1,1,0,9,,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