No office rate
Use the modified radical code when the breast and axillary nodes are removed but the pectoral muscles are preserved. This code represents removal of those muscles as well.
On this page
CMS RVU26D · Effective 2026-10-01
19305 Mastectomy Medicare reimbursement rates in Iowa
Reports removal of the breast, pectoral muscles, and axillary lymph nodes in a radical operation for extensive breast cancer. Compare 19305 office and facility rates across CMS payment localities in Iowa.
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 19305 in Iowa?
Iowa 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
No supported rate
Facility setting
$975.71
1 of 1 localities have a supported rate.
Payment area: Iowa
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 19305: Radical mastectomy with muscle removal
Reports removal of the breast, pectoral muscles, and axillary lymph nodes in a radical operation for extensive breast cancer.
This operation removes the breast together with the pectoral muscles and axillary lymph nodes. It is an uncommon, extensive approach for breast cancer and is typically performed by a breast or surgical oncologist in a hospital operating room. The operative report should identify the structures removed and the extent of the axillary dissection; the documented procedure, rather than the cancer diagnosis alone, supports selection of this code.
Report the code when the operation includes the full radical extent, not for a mastectomy that preserves the pectoral muscles or removes only part of the breast. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, 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 may be available; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 19305
- 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
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU17.02 · 52%
- Practice expense (office) RVU11.42 · 35%
- Malpractice RVU4.39 · 13%
155
Medicare services in 2024 · #4535 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.
19305 compared with similar codes
Office rates for Iowa, from the same CMS release.
No office rate
The extended radical variant includes internal mammary lymph node removal in addition to the radical mastectomy extent.
No office rate
A complete mastectomy without the radical removal of pectoral muscles and axillary lymph nodes is reported with this code.
No office rate
This code represents partial breast removal with axillary lymph node removal, rather than removal of the entire breast and pectoral muscles.
Compare 19305 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
Iowa →
Office / nonfacility
Unavailable
Facility
$975.71
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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 19305 in Iowa.
PPRRVU2026_Oct_nonQPP.csv
1,689
- Code
- 19305
- Physician work
- 17.02
- Practice expense
- 11.42
- Malpractice
- 4.39
GPCI2026.csv
53
- Locality
- Iowa
- Physician work
- 1.000
- Practice expense
- 0.915
- Malpractice
- 0.397
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 17.02 | × 1.000 | 17.0200 |
| Practice expense | 11.42 | × 0.915 | 10.4493 |
| Malpractice | 4.39 | × 0.397 | 1.7428 |
| Total RVUs | 29.2121 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Iowa$975.71
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 17.02 | 1 |
| Practice expense | 11.42 | 0.915 |
| Malpractice | 4.39 | 0.397 |
(17.02 × 1 + 11.42 × 0.915 + 4.39 × 0.397) × $33.4009 = $975.71
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.
19305 billing questions
How does this differ from a modified radical mastectomy?
This code includes removal of the pectoral muscles along with the breast and axillary lymph nodes. The modified radical procedure preserves the pectoral muscles.
Does this code include axillary lymph node removal?
Yes. Axillary lymph node removal is part of the radical operation represented by this code.
Can breast reconstruction be reported with this mastectomy?
Immediate reconstruction may be performed in the same session and reported separately when supported by the documented reconstructive service. For example, tissue expander placement may accompany mastectomy.
How is bilateral surgery reported?
CMS identifies this as a bilateral procedure; reporting modifier 50 is paid at 150%.
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?
Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation; team surgery is 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 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.
1,68619301,,Partial mastectomy,A,,9.88,6.52,NA,6.52,,2.54,18.94,18.94,0,090,0.10,0.71,0.19,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,68719302,,P-mastectomy w/ln removal,A,,13.64,8.82,NA,8.82,,3.51,25.97,25.97,0,090,0.10,0.71,0.19,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,68819303,,Mast simple complete,A,,14.63,9.04,NA,9.04,,3.75,27.42,27.42,0,090,0.10,0.71,0.19,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,68919305,,Mast radical,A,,17.02,11.42,NA,11.42,,4.39,32.83,32.83,0,090,0.10,0.71,0.19,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,69019306,,Mast rad urban type,A,,17.68,12.83,NA,12.83,,4.73,35.24,35.24,0,090,0.10,0.71,0.19,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,69119307,,Mast mod rad,A,,17.54,11.66,NA,11.66,,4.53,33.73,33.73,0,090,0.10,0.71,0.19,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,69219316,,Mastopexy,A,,10.81,8.89,NA,8.89,,2.13,21.83,21.83,0,090,0.10,0.71,0.19,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772
5106102,IL,99,REST OF ILLINOIS,1.000,0.913,1.563
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915
5607202,LA,01,NEW ORLEANS,1.000,0.941,1.136