Billing code 19101: Breast biopsyMedicare rate & RVUs in Oregon
Reports surgical sampling of breast tissue through an incision when an open incisional biopsy is performed rather than percutaneous sampling or lesion removal.
Medicare pays $341.66–$369.59 for 19101 in the office in Oregon, from Rest Of Oregon to Portland. 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 19101 covers
A surgeon makes an incision in the breast and removes a tissue sample for diagnostic examination. This approach may be selected when a breast mass or other suspicious area needs tissue diagnosis and an open sample is performed instead of a percutaneous biopsy. The service is commonly performed by a breast surgeon or general surgeon in an operating room or other surgical setting, with the specimen sent for pathology examination.
Report this code for open incisional sampling, not when the procedure removes the breast lesion as a whole. The operative note should identify the breast and site, describe the open sampling approach, and document the tissue obtained. Related postoperative visits during the 10-day global period are included. For multiple procedures in one session, Medicare pays the highest-valued procedure in full and other procedures at 50%. For bilateral reporting with modifier 50, payment is 150%. Medicare does not pay an assistant at surgery for this service; 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.
Where 19101 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | $369.59 | $220.78 |
| Rest Of Oregon | $341.66 | $208.26 |
How the 19101 rate is calculated
Each of 19101’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 · 19101
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 3.15Practice expense 6.55Malpractice 0.79
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 19101
19101 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 19101
Breast biopsy
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| 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. |
| Split (54/55/56) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 19101
Breast biopsy
10-day global period ends
Oct 11, 2026
Covers Oct 1, 2026 through Oct 11, 2026 (11 days).
Visit on Oct 31, 2026
After the global period ends: visits and procedures are billed normally.
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
19101 without 50 · national office
$350.38
Breast biopsy
19101-50 · Bilateral: 150%
$525.57
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
19101 compared with similar codes
Compare codes
19101 vs 19100 vs 19083 vs 19120 vs 19125: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 19100Breast biopsy
- 19100 describes percutaneous breast sampling without imaging guidance. Choose 19101 when the surgeon obtains the sample through an incision.
- 19083Breast biopsy
- 19083 is a percutaneous biopsy performed with ultrasound guidance and includes localization-device placement when performed; 19101 is an open incisional biopsy.
- 19120Breast lesion excision
- 19120 is for removal of a breast lesion. Use 19101 when the operative service is incisional sampling rather than removal of the lesion.
- 19125Breast lesion excision
- 19125 describes excision of a breast lesion identified by preoperative radiological localization. It is not the open incisional sampling represented by 19101.
19101 billing questions
When should 19101 be chosen over 19100?
Use 19101 for an open incisional sample obtained through a surgical incision. Code 19100 describes percutaneous breast sampling without imaging guidance.
How does 19101 differ from excision of a breast lesion?
19101 represents sampling of tissue through an incision. When the procedure removes the lesion rather than taking an incisional sample, consider an excision code such as 19120.
Can pathology be reported separately?
The tissue specimen may be examined and reported by a pathologist using an appropriate surgical pathology code, such as 88305, when the pathology service is performed.
How is bilateral breast biopsy reported?
CMS lists this as a bilateral procedure; modifier 50 is paid at 150%. The documentation should support open incisional biopsy on both sides.
Is an assistant surgeon payable for 19101?
No. CMS identifies a statutory restriction on assistant-at-surgery payment for this code. Co-surgeons and team surgery are also not permitted.
What postoperative care is included?
Related postoperative visits during the 10-day global period are included in the procedure.
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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