$644.94
19125 reports excision of the first breast lesion identified by preoperative radiological marking. Add 19126 for each additional separately localized lesion excised.
On this page
CMS RVU26D · Effective 2026-10-01
19126 Breast lesion excision Medicare reimbursement rates in Rhode Island
Reports open excision of each additional breast lesion identified by preoperative radiological marking, alongside the primary localized-lesion excision. Compare 19126 office and facility rates across CMS payment localities in Rhode Island.
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 19126 in Rhode Island?
Rhode Island 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
$143.93
1 of 1 localities have a supported rate.
Payment area: Rhode Island
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 19126: Additional localized breast lesion excision
Reports open excision of each additional breast lesion identified by preoperative radiological marking, alongside the primary localized-lesion excision.
This add-on represents open removal of an additional breast lesion that was identified by preoperative radiological marking. A breast surgeon or other operating surgeon excises the separately localized lesion, often during the same operation as removal of the first localized lesion. It is suited to cases with more than one distinct lesion selected for excision, including nonpalpable findings localized before surgery.
Report 19126 with 19125 for each additional localized lesion beyond the first; do not report it by itself. The operative record should support the separate lesion excised and its preoperative radiological localization. CMS treats this as an add-on code billed with a primary procedure, with payment within that procedure’s global period.
CMS billing rules for 19126
- Global period
- Add-on code: billed only together with a primary procedure and paid within that procedure's global period.
Where the value comes from
- Work RVU2.86 · 66%
- Practice expense (office) RVU0.72 · 17%
- Malpractice RVU0.73 · 17%
475
Medicare services in 2024 · #3609 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.
19126 compared with similar codes
Office rates for Rhode Island, from the same CMS release.
$582.55
19120 describes open breast-lesion excision without the specific radiological-marker localization structure used for 19125 and 19126.
$356.74
19101 is an open breast biopsy, whereas 19126 represents excision of an additional lesion identified by preoperative radiological marking.
Compare 19126 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
Rhode Island →
Office / nonfacility
Unavailable
Facility
$143.93
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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 19126 in Rhode Island.
PPRRVU2026_Oct_nonQPP.csv
1,672
- Code
- 19126
- Physician work
- 2.86
- Practice expense
- 0.72
- Malpractice
- 0.73
GPCI2026.csv
92
- Locality
- Rhode Island
- Physician work
- 1.019
- Practice expense
- 1.033
- Malpractice
- 0.892
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.86 | × 1.019 | 2.9143 |
| Practice expense | 0.72 | × 1.033 | 0.7438 |
| Malpractice | 0.73 | × 0.892 | 0.6512 |
| Total RVUs | 4.3093 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Rhode Island$143.93
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.86 | 1.019 |
| Practice expense | 0.72 | 1.033 |
| Malpractice | 0.73 | 0.892 |
(2.86 × 1.019 + 0.72 × 1.033 + 0.73 × 0.892) × $33.4009 = $143.93
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.
19126 billing questions
When should 19126 be reported instead of 19125?
Use 19125 for the first breast lesion identified by preoperative radiological marking and 19126 for each additional separately localized lesion excised during the operation.
Can 19126 be billed by itself?
No. It is an add-on code reported with 19125, the primary localized-lesion excision.
What documentation supports an additional unit?
The operative record should establish that another distinct lesion was excised and that it had been identified by preoperative radiological marking.
How is 19126 paid under the CMS rule?
CMS identifies it as an add-on billed with a primary procedure, with payment within that procedure’s global period.
How does 19126 differ from 19120?
19126 is for an additional lesion identified by preoperative radiological marking and accompanies 19125. 19120 describes breast lesion excision without that specific localization-code structure.
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.
1,66919112,,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
1,67519283,,Perq dev breast 1st strtctc,A,,1.95,5.33,,0.36,,0.21,7.49,2.52,0,000,0.00,0.00,0.00,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
8912502,PA,01,METROPOLITAN PHILADELPHIA,1.018,1.041,1.193
9012502,PA,99,REST OF PENNSYLVANIA,1.000,0.918,0.945
9109202,PR,20,PUERTO RICO,1.000,1.011,0.985
9214412,RI,01,RHODE ISLAND,1.019,1.033,0.892
9311202,SC,01,SOUTH CAROLINA,1.000,0.924,0.850
9403402,SD,02,SOUTH DAKOTA**,1.000,1.000,0.336
9510312,TN,35,TENNESSEE,1.000,0.909,0.537