No office rate
19301 is for partial breast removal; 19303 is for removal of the entire breast.
On this page
CMS RVU26D · Effective 2026-10-01
19303 Mastectomy Medicare reimbursement rates in Vermont
Removal of the entire breast, including the nipple-areolar complex, without formal axillary dissection, for cancer treatment or risk-reducing surgery. Compare 19303 office and facility rates across CMS payment localities in Vermont.
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 19303 in Vermont?
Vermont 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
$850.96
1 of 1 localities have a supported rate.
Payment area: Vermont
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 19303: Complete simple mastectomy
Removal of the entire breast, including the nipple-areolar complex, without formal axillary dissection, for cancer treatment or risk-reducing surgery.
A simple complete mastectomy removes the breast tissue and nipple-areolar complex without a formal axillary lymph node dissection. Breast surgeons typically perform it in a hospital or ambulatory surgical setting for breast cancer treatment or risk-reducing surgery. Sentinel lymph node sampling may be performed during the same operative session, but it is distinct from a full axillary dissection.
Report 19303 when the operative record supports removal of the whole breast rather than a partial mastectomy; document the extent of tissue removal and any axillary procedure separately. The code has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For bilateral surgery, modifier 50 is paid at 150%. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and others at 50%. An assistant at surgery may be paid; co-surgeons require supporting documentation, and team surgery is not permitted.
CMS billing rules for 19303
- 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 may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU14.63 · 53%
- Practice expense (office) RVU9.04 · 33%
- Malpractice RVU3.75 · 14%
21.7K
Medicare services in 2024 · #1116 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.
19303 compared with similar codes
Office rates for Vermont, from the same CMS release.
No office rate
19302 describes partial mastectomy with axillary lymphadenectomy, not a simple complete mastectomy.
No office rate
19307 is a modified radical mastectomy involving axillary dissection; 19303 describes complete breast removal without formal axillary dissection.
$613.09
19300 is for mastectomy for gynecomastia, rather than complete mastectomy for breast cancer treatment or risk reduction.
Compare 19303 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
Vermont →
Office / nonfacility
Unavailable
Facility
$850.96
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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 19303 in Vermont.
PPRRVU2026_Oct_nonQPP.csv
1,688
- Code
- 19303
- Physician work
- 14.63
- Practice expense
- 9.04
- Malpractice
- 3.75
GPCI2026.csv
105
- Locality
- Vermont
- Physician work
- 1.000
- Practice expense
- 0.990
- Malpractice
- 0.506
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 14.63 | × 1.000 | 14.6300 |
| Practice expense | 9.04 | × 0.990 | 8.9496 |
| Malpractice | 3.75 | × 0.506 | 1.8975 |
| Total RVUs | 25.4771 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Vermont$850.96
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 14.63 | 1 |
| Practice expense | 9.04 | 0.99 |
| Malpractice | 3.75 | 0.506 |
(14.63 × 1 + 9.04 × 0.99 + 3.75 × 0.506) × $33.4009 = $850.96
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.
19303 billing questions
How does 19303 differ from a partial mastectomy?
Use 19303 when the entire breast is removed. A partial mastectomy, reported with 19301, removes only part of the breast.
Does 19303 include axillary lymph node dissection?
No. A formal axillary dissection is not part of a simple complete mastectomy; choose the applicable mastectomy code when that dissection is performed. Sentinel node sampling is a distinct procedure.
Can sentinel lymph node biopsy be reported with 19303?
It may be reported separately when performed during the same operative session. The operative documentation should identify the node procedure and its extent.
How is bilateral 19303 reported for Medicare?
CMS identifies this as a bilateral procedure; modifier 50 is paid at 150%.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can breast reconstruction be performed and reported at the same session?
Immediate reconstruction may accompany mastectomy. The reconstruction code depends on the method, such as direct implant placement or tissue-expander placement, and the operative record should describe the work performed.
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.
1,68519300,,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
1,69019306,,Mast rad urban type,A,,17.68,12.83,NA,12.83,,4.73,35.24,35.24,0,090,0.10,0.71,0.19,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,69119307,,Mast mod rad,A,,17.54,11.66,NA,11.66,,4.53,33.73,33.73,0,090,0.10,0.71,0.19,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817