Billing code 19000: Breast aspirationMedicare rate & RVUs in Ohio
Reports needle aspiration of a breast cyst, typically to relieve symptoms or evaluate a fluid-filled lesion without taking a core tissue sample.
Medicare pays $90.56 for 19000 in the office in Ohio (Ohio). Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 19000 covers
A clinician uses a needle to withdraw fluid from a breast cyst, commonly one that is palpable, uncomfortable, or identified on imaging. The service may be performed in an office or facility by a physician involved in breast care, such as a breast surgeon or radiologist. Aspiration removes cyst fluid; it is distinct from taking a core tissue sample from a breast lesion.
Report 19000 for the first cyst aspirated in the session and 19001 for each additional cyst. Document the cyst’s location, the clinical reason for aspiration, and the aspiration performed; identify additional cysts when reporting the add-on code. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery, and co-surgeons and team surgery are not permitted.
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.
19000 in Ohio
| Payment locality | Office | Facility |
|---|---|---|
| Ohio | $90.56 | $35.97 |
How the 19000 rate is calculated
Each of 19000’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 19000
RVUs × geographic indexes × conversion factor
Work0.82
0.82 RVUs× 1.000 GPCI
Practice expense1.95
1.95 RVUs× 1.000 GPCI
Malpractice0.11
0.11 RVUs× 1.000 GPCI
Adjusted RVUs
2.8800
Conversion factor
$33.4009
Medicare rate
$96.19
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 19000
The CMS indicators that decide how 19000 is paid alongside other services.
CMS payment indicators · 19000
Breast aspiration
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
19000 without 51 · national office
$96.19
Breast aspiration
19000-51 · Second procedure: 50%
$48.10
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
19000 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 19001Breast cyst aspiration
- 19000 reports aspiration of the first cyst; 19001 reports each additional cyst aspirated in the session.
- 19083Breast biopsy
- 19083 is for ultrasound-guided core biopsy of a breast lesion. Use 19000 when the service is needle aspiration of cyst fluid, not core tissue sampling.
- 19020Breast abscess drainage
- 19020 describes incision and drainage of a deep breast abscess. 19000 is needle aspiration of a breast cyst.
19000 billing questions
When should 19001 be reported instead of 19000?
Report 19000 for the first breast cyst aspirated. Report 19001 for each additional cyst aspirated during the session.
Is cyst aspiration the same as a breast core biopsy?
No. Aspiration withdraws fluid from a cyst; a core biopsy obtains tissue from a lesion. Use the code that reflects the service actually performed.
Can modifier 50 be used when cysts in both breasts are aspirated?
No. CMS identifies bilateral adjustment as inappropriate for this code, so do not use modifier 50.
Does 19000 have a global period?
It has a 0-day global period. Same-day preoperative and postoperative care is included.
How does the multiple-procedure rule affect 19000?
When it is performed with other procedures in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction.
Can an assistant surgeon or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this service. Co-surgeons and team surgery are 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 indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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