$517.47
Use 19125 when the single excised lesion was identified by a preoperative radiological marker. Use 19120 for open lesion excision when that marker-based identification does not define the service.
On this page
CMS RVU26D · Effective 2026-10-01
19125 Breast lesion excision Medicare reimbursement rates in Nebraska
Reports surgical excision of a single breast lesion identified by a preoperative radiological marker, commonly when the lesion is difficult to locate by touch. Compare 19125 office and facility rates across CMS payment localities in Nebraska.
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 19125 in Nebraska?
Nebraska 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
$572.25
1 of 1 localities have a supported rate.
Payment area: Nebraska
One mapped payment locality.
Facility setting
$403.92
1 of 1 localities have a supported rate.
Payment area: Nebraska
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 19125: Localized breast lesion excision
Reports surgical excision of a single breast lesion identified by a preoperative radiological marker, commonly when the lesion is difficult to locate by touch.
Code 19125 describes a surgeon’s removal of one breast lesion identified before surgery with a radiological marker, commonly a localization wire. It is typically used for a nonpalpable or difficult-to-localize target found on breast imaging. A radiologist or other qualified clinician may place the marker before the patient goes to the operating room; the surgeon then uses it to locate and excise the target. The code represents the excision, not the marker-placement service.
Select 19125 when the operative report documents excision of one marker-identified lesion. The record should support the target, its location, and the completed removal. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. In a same-session multiple-procedure claim, 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-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 19125
- 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 paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU6.52 · 34%
- Practice expense (office) RVU10.81 · 57%
- Malpractice RVU1.68 · 9%
10.2K
Medicare services in 2024 · #1456 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.
19125 compared with similar codes
Office rates for Nebraska, from the same CMS release.
No office rate
19125 reports excision of the first marker-identified lesion; 19126 is the add-on for each additional lesion excised in the same session.
$317.12
19101 is an open diagnostic biopsy involving tissue sampling. 19125 reports surgical excision of a lesion localized by a preoperative radiological marker.
Compare 19125 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
Nebraska →
Office / nonfacility
$572.25
Facility
$403.92
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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 19125 in Nebraska.
PPRRVU2026_Oct_nonQPP.csv
1,671
- Code
- 19125
- Physician work
- 6.52
- Practice expense
- 10.81
- Malpractice
- 1.68
GPCI2026.csv
72
- Locality
- Nebraska
- Physician work
- 1.000
- Practice expense
- 0.923
- Malpractice
- 0.378
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 6.52 | × 1.000 | 6.5200 |
| Practice expense | 10.81 | × 0.923 | 9.9776 |
| Malpractice | 1.68 | × 0.378 | 0.6350 |
| Total RVUs | 17.1327 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Nebraska$572.25
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 6.52 | 1 |
| Practice expense | 10.81 | 0.923 |
| Malpractice | 1.68 | 0.378 |
(6.52 × 1 + 10.81 × 0.923 + 1.68 × 0.378) × $33.4009 = $572.25
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 6.52 | 1 |
| Practice expense | 5.35 | 0.923 |
| Malpractice | 1.68 | 0.378 |
(6.52 × 1 + 5.35 × 0.923 + 1.68 × 0.378) × $33.4009 = $403.92
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.
19125 billing questions
How is 19125 different from 19120?
19125 is for excision of a lesion identified by a preoperative radiological marker. 19120 is the open excision code when that marker-based identification is not the defining circumstance.
Can 19125 be reported for more than one lesion?
19125 describes one marker-identified lesion. For an additional lesion, report 19126 when its requirements are met.
Is placement of the breast localization device included?
The marker-placement service is separate from the excision. When performed and documented, the appropriate localization-placement code may be reported by the clinician performing that service.
What documentation supports 19125?
The operative report should establish that the excised lesion was identified by a preoperative radiological marker and document the target and its location.
How does Medicare handle bilateral 19125?
When the procedure is performed bilaterally and reported with modifier 50, CMS pays the bilateral procedure at 150%.
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.
1,66819110,,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
1,67219126,,Excision addl breast lesion,A,,2.86,0.72,NA,0.72,,0.73,4.31,4.31,0,ZZZ,0.00,0.00,0.00,0,0,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,67319281,,Perq device breast 1st imag,A,,1.95,4.89,,0.35,,0.19,7.03,2.49,0,000,0.00,0.00,0.00,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,67419282,,Perq device breast ea imag,A,,0.98,3.87,,0.18,,0.08,4.93,1.24,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6905302,MO,01,METROPOLITAN ST. LOUIS,1.000,0.952,1.002
7005302,MO,99,REST OF MISSOURI,1.000,0.862,0.974
7103202,MT,01,MONTANA**,1.000,1.000,0.998
7205402,NE,00,NEBRASKA,1.000,0.923,0.378
7301312,NV,00,NEVADA**,1.000,1.001,0.833
7414312,NH,40,NEW HAMPSHIRE,1.000,1.041,0.875
7512402,NJ,01,NORTHERN NJ,1.063,1.160,1.068