Billing code 19110: Nipple explorationMedicare rate & RVUs in Texas
Operative exploration of the nipple and lactiferous duct, often for pathologic nipple discharge, with possible removal of a solitary duct.
Medicare pays $500.05–$550.82 for 19110 in the office in Texas, from Beaumont to Austin. 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 19110 covers
This service involves surgically examining the nipple and its ductal system, commonly when pathologic nipple discharge prompts operative evaluation. The surgeon may remove a solitary duct during the exploration. Breast or general surgeons typically perform the procedure in an operating-room setting to identify or treat a duct-related source of discharge; it is distinct from removing a separate breast lesion.
Report 19110 when the operative work is nipple or duct exploration, rather than needle sampling or excision of a breast lesion. The operative note should support the discharge or other indication, the nipple and side treated, the exploration performed, and any duct removed. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, 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-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 19110 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 payment localities
$500.05 to $550.82
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | $550.82 | $361.76 |
| Beaumont | $500.05 | $337.44 |
| Brazoria | $524.10 | $347.01 |
| Dallas | $528.95 | $350.97 |
| Fort Worth | $525.92 | $349.73 |
| Galveston | $526.62 | $349.17 |
| Houston | $547.30 | $369.85 |
| Rest Of Texas | $512.80 | $343.22 |
How the 19110 rate is calculated
Each of 19110’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 · 19110
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 4.33Practice expense 10.54Malpractice 1.13
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 19110
19110 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 19110
Nipple exploration
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 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) | 0.10/0.71/0.19 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 19110
Nipple exploration
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
19110 without 50 · national office
$534.41
Nipple exploration
19110-50 · Bilateral: 150%
$801.62
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).
19110 compared with similar codes
Compare codes
19110 vs 19100 vs 19101 vs 19112 vs 19120: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 19100Breast biopsy
- 19100 is percutaneous breast biopsy without imaging guidance. Choose 19110 for operative exploration of the nipple or ductal system, not needle sampling.
- 19101Breast biopsy
- 19101 describes open breast biopsy. Choose 19110 when the operative work is nipple-duct exploration rather than open tissue sampling.
- 19112Breast surgery
- 19112 is for excision of a breast duct fistula. 19110 concerns exploration of the nipple duct, commonly prompted by pathologic discharge.
- 19120Breast lesion excision
- 19120 describes removal of a breast lesion. 19110 is selected for nipple or duct exploration, not excision of a separate breast lesion.
19110 billing questions
When is 19110 preferable to a breast biopsy code?
Use 19110 when the surgeon operates to explore the nipple or ductal system, commonly for pathologic discharge. A breast biopsy code describes sampling breast tissue rather than nipple-duct exploration.
Can a solitary duct be removed during this service?
Yes. Removal of a solitary duct may be part of the nipple exploration; document the ductal work performed.
How should bilateral exploration be reported?
CMS lists modifier 50 for bilateral reporting, with payment at 150%. Document the procedure on both sides.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be paid?
CMS applies a statutory restriction on assistant-at-surgery payment for this code. Co-surgeons and team surgery are not permitted.
How are other procedures in the same session paid?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%.
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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