$167.40–$188.97
19100 is percutaneous tissue sampling without imaging guidance. Use 19120 when the surgeon removes the lesion through an open incision.
On this page
CMS RVU26D · Effective 2026-10-01
19120 Breast lesion excision Medicare reimbursement rates in Washington
Open removal of one or more breast lesions, such as a palpable fibroadenoma, when excision rather than needle sampling or marker-localized removal is performed. Compare 19120 office and facility rates across CMS payment localities in Washington.
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 19120 in Washington?
Washington has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
$581.69–$649.30
2 of 2 localities have a supported rate.
Facility setting
$407.59–$446.43
2 of 2 localities have a supported rate.
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 19120: Open excision of breast lesion
Open removal of one or more breast lesions, such as a palpable fibroadenoma, when excision rather than needle sampling or marker-localized removal is performed.
A surgeon removes breast tissue containing a cyst, fibroadenoma, or other lesion through an open incision. The specimen may include a palpable mass, abnormal duct tissue, aberrant breast tissue, or a nipple or areolar lesion. General or breast surgeons commonly perform the operation in an ambulatory surgery center or hospital operating room; selected cases may be done in an office procedure setting. This code covers one or more lesions when the operation is an excision, rather than needle sampling or removal of a lesion identified by a preoperative radiologic marker.
Choose 19120 based on the operative approach and target, not pathology findings alone. Document the breast and site, the lesion or lesions removed, and the open excision. The code has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For bilateral work, modifier 50 is paid at 150%. When multiple procedures occur in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Medicare does not pay an assistant at surgery for this service; co-surgeons and team surgery are not permitted.
CMS billing rules for 19120
- 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
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU5.77 · 34%
- Practice expense (office) RVU9.94 · 58%
- Malpractice RVU1.45 · 8%
6K
Medicare services in 2024 · #1764 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.
19120 compared with similar codes
Office rates for Washington, from the same CMS release.
$357.03–$400.47
19101 describes open breast biopsy. Use 19120 when the operative service is excision of the lesion rather than diagnostic tissue sampling.
$643.51–$717.53
19125 is for open excision of a lesion identified by preoperative placement of a radiologic marker; 19120 is for other qualifying open lesion excisions.
No office rate
19126 is an add-on for each additional marker-localized lesion removed with 19125. It is not an additional-lesion code for 19120.
Compare 19120 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.
2 of 2 payment localities
Rest Of Washington →
Office / nonfacility
$581.69
Facility
$407.59
Seattle (King Cnty) →
Office / nonfacility
$649.30
Facility
$446.43
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19120 billing questions
When should 19120 be chosen instead of 19125?
Use 19120 for open excision of one or more breast lesions not identified by preoperative placement of a radiologic marker. Use 19125 for an open excision of a lesion identified by that marker.
Can 19120 be reported for more than one lesion?
Yes. The code covers one or more lesions, so do not report extra units solely because multiple qualifying lesions were removed.
How does 19120 differ from a breast biopsy code?
19120 represents open removal of the lesion, while 19100 is percutaneous sampling and 19101 is open biopsy. Choose based on the procedure actually performed, not just the eventual pathology result.
How is bilateral excision reported?
Report modifier 50 for bilateral work; CMS pays the bilateral procedure at 150%.
Is an assistant surgeon payable for 19120?
No. Medicare does not pay an assistant at surgery for this code, and 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 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.
1,66719105,,Cryosurg ablate fa each,A,,3.60,71.34,,1.22,,0.98,75.92,5.80,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,66819110,,Nipple exploration,A,,4.33,10.54,,5.19,,1.13,16.00,10.65,0,090,0.10,0.71,0.19,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,66919112,,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