No office rate
Choose 19302 when axillary lymphadenectomy is part of the partial mastectomy; 19301 describes the breast-conserving resection without that added operation.
On this page
CMS RVU26D · Effective 2026-10-01
19301 Partial mastectomy Medicare reimbursement rates in New Jersey
Report 19301 for breast-conserving surgery that removes a breast lesion with surrounding tissue, commonly for cancer or ductal carcinoma in situ. Compare 19301 office and facility rates across CMS payment localities in New Jersey.
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 19301 in New Jersey?
New Jersey has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$674.08–$694.02
2 of 2 localities have a supported rate.
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 19301: Breast-conserving partial mastectomy
Report 19301 for breast-conserving surgery that removes a breast lesion with surrounding tissue, commonly for cancer or ductal carcinoma in situ.
A breast surgeon removes a lesion and a surrounding portion of breast tissue while preserving the remainder of the breast. This is commonly performed for breast cancer or ductal carcinoma in situ, in a hospital or ambulatory surgical setting. The operative report should identify the breast and site, the lesion being treated, and the extent of tissue removed. Axillary node surgery is a separate part of the operation when performed and may be reported with an appropriate node procedure code.
Select 19301 when the operation is a partial mastectomy, rather than a simple complete mastectomy or an excision reported as a breast lesion excision. The 90-day global period includes the day-before preoperative visit and related postoperative care through day 90. For multiple procedures in one session, the highest-valued procedure is paid in full and the others at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment requires documentation of medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 19301
- 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 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 RVU9.88 · 52%
- Practice expense (office) RVU6.52 · 34%
- Malpractice RVU2.54 · 13%
69.3K
Medicare services in 2024 · #677 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.
19301 compared with similar codes
Office rates for New Jersey, from the same CMS release.
No office rate
19303 is for complete removal of the breast; 19301 preserves breast tissue by removing a portion.
$616.11–$641.72
19301 represents a partial mastectomy, commonly an oncologic breast-conserving operation with surrounding tissue removed. 19120 is used for breast lesion excision when the procedure is not a partial mastectomy.
No office rate
19307 describes a modified radical mastectomy. It is distinct from the breast-conserving resection reported with 19301.
Compare 19301 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.
2 of 2 payment localities
Northern Nj →
Office / nonfacility
Unavailable
Facility
$694.02
Rest Of New Jersey →
Office / nonfacility
Unavailable
Facility
$674.08
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19301 billing questions
How does 19301 differ from 19302?
19301 describes breast-conserving partial mastectomy. Use 19302 when the operation also includes axillary lymphadenectomy.
Can sentinel node surgery be reported with 19301?
Yes, when a distinct sentinel lymph node procedure is performed during the encounter. The operative documentation should support the node procedure as well as the breast resection.
When is 19303 a better choice?
Use 19303 for a simple complete mastectomy, rather than an operation that preserves part of the breast.
How is bilateral 19301 reported?
CMS lists bilateral reporting with modifier 50 and payment at 150%. The operative record should support surgery on both breasts.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care through day 90.
What supports assistant-at-surgery payment?
Documentation must establish the medical necessity of the assistant at surgery.
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.
1,68319297,,Place breast cath for rad,A,,1.68,0.40,NA,0.40,,0.41,2.49,2.49,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,68419298,,Place breast rad tube/caths,A,,5.61,19.44,,1.84,,0.44,25.49,7.89,0,000,0.00,0.00,0.00,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,68519300,,Mastectomy for gynecomastia,A,,5.18,12.69,,6.36,,1.21,19.08,12.75,0,090,0.10,0.71,0.19,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,68619301,,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