Breast Surgery CPT Codes: Biopsy, Lumpectomy, Mastectomy Coding Guide

Breast surgery represents one of the most complex and frequently performed procedures in surgical oncology, with over 280,000 breast cancer surgeries performed annually in the United States. Accurate CPT coding for breast procedures requires precise understanding of surgical approaches, specimen handling, lymph node evaluation, and bilateral considerations that significantly impact reimbursement.

This comprehensive guide covers the essential breast surgery CPT codes from diagnostic biopsies through definitive surgical management, including proper modifier usage for bilateral procedures, sentinel lymph node mapping, and the critical ICD-10 diagnosis codes that ensure optimal coding compliance and reimbursement.

Breast Biopsy CPT Codes

CPT Code	Description	Approach	RVU	Global Period
19100	Biopsy of breast; percutaneous, needle core, not using imaging guidance	Core needle	2.41	0 days
19101	Biopsy of breast; open, incisional	Open surgical	4.12	10 days
19102	Biopsy of breast; percutaneous, needle core, using imaging guidance	Image-guided core	3.18	0 days
19103	Biopsy of breast; percutaneous, automated vacuum assisted or rotating biopsy device	Vacuum-assisted	3.95	0 days

CPT 19100: Core Needle Biopsy (No Imaging)

CPT 19100 applies to palpable breast lesions biopsied with core needle technique without imaging guidance:

• Palpable mass requiring tissue diagnosis
• 14-gauge or larger core needle
• Multiple tissue samples obtained
• No concurrent imaging guidance
• Local anesthesia included

This code has largely been superseded by image-guided techniques for improved accuracy and reduced sampling error.

CPT 19101: Open Incisional Biopsy

Open incisional biopsy is now reserved for specific clinical scenarios:

• Discordant imaging and core biopsy results
• High-risk lesions requiring larger tissue samples
• Suspected lymphoma requiring architecture preservation
• Technical inability to perform percutaneous biopsy
• Patient factors precluding needle biopsy

The 10-day global period includes routine post-biopsy care but excludes definitive surgical treatment if cancer is diagnosed.

Breast Conservation Surgery

CPT 19120: Excision of Benign Lesion

CPT 19120 covers excision of benign breast lesions:

• Single benign lesion removal
• Fibroadenoma excision
• Papilloma removal
• High-risk lesion excision (LCIS, ALH, ADH)
• Margins not oncologically critical

CPT 19125: Excision with Preoperative Localization

CPT 19125 addresses non-palpable lesions requiring preoperative localization:

• Wire-guided localization
• Radioactive seed localization
• Magnetic seed localization (Magseed)
• Radar reflector localization (SAVI SCOUT)
• Non-palpable suspicious lesions

Important: The localization procedure itself requires separate coding (19281-19288) and should not be bundled with the excision code.

CPT 19301: Partial Mastectomy (Lumpectomy)

CPT 19301 represents breast-conserving surgery for malignant lesions:

• Lumpectomy with oncologic margins
• Tylectomy (wide local excision)
• Quadrantectomy
• Segmentectomy
• Margins assessed for residual disease

This code encompasses any breast-conserving procedure where the goal is complete tumor excision with clear margins while preserving breast tissue.

Mastectomy Procedures

CPT Code	Description	Tissue Removed	RVU
19303	Mastectomy, simple, complete	Breast tissue, nipple-areolar complex	10.15
19305	Mastectomy, radical, including pectoral muscles, axillary lymph nodes	Breast, pectoralis major/minor, axillary nodes	20.84
19307	Mastectomy, modified radical, including axillary lymph nodes	Breast, axillary lymph nodes, pectoralis fascia	14.67
19316	Mastopexy	Breast reshaping (cosmetic)	11.32

CPT 19303: Simple/Total Mastectomy

Simple mastectomy removes all breast tissue while preserving the pectoralis muscle and axillary lymph nodes:

• Prophylactic mastectomy for high-risk patients
• Ductal carcinoma in situ (DCIS)
• Early-stage cancer not requiring nodal dissection
• Nipple-sparing or skin-sparing approaches
• May include immediate reconstruction planning

CPT 19307: Modified Radical Mastectomy

Modified radical mastectomy combines breast removal with axillary lymph node dissection:

• Invasive breast cancer requiring nodal evaluation
• Clinically positive axillary nodes
• Failed sentinel lymph node mapping
• Previous axillary surgery preventing sentinel node procedure
• Inflammatory breast cancer

This procedure includes Levels I and II axillary dissection but preserves the pectoralis major muscle.

Lymph Node Procedures

CPT 38900: Sentinel Lymph Node Biopsy

Sentinel lymph node biopsy is the standard of care for clinically node-negative breast cancer:

• Invasive breast cancer ≤5cm
• Clinically negative axillary nodes
• No previous axillary surgery
• Can be performed with radioisotope and/or blue dye
• May include ICG (indocyanine green) fluorescence

CPT 38745: Axillary Lymph Node Dissection

Complete axillary lymph node dissection when sentinel node mapping fails or is positive:

• Positive sentinel lymph nodes (selective cases)
• Failed sentinel node mapping
• Clinically positive axillary nodes
• Neoadjuvant chemotherapy with residual nodal disease
• Inflammatory breast cancer

Standard dissection includes Levels I and II lymph nodes with preservation of the thoracodorsal and long thoracic nerves.

Bilateral Procedures and Modifier Usage

Modifier -50 vs Modifier -59

Bilateral breast procedures require careful modifier application:

Use Modifier -50 (Bilateral Procedure):

• Bilateral prophylactic mastectomy
• Bilateral breast biopsies during same operative session
• Bilateral breast reductions
• Same procedure performed on both breasts

Use Modifier -59 (Distinct Procedural Service):

• Different procedures on each breast
• Lumpectomy on one side, mastectomy on the other
• Biopsy and therapeutic procedure on same breast
• Multiple distinct lesions in different quadrants

Bilateral Coding Examples

Scenario 1: Bilateral prophylactic mastectomy

• Code: 19303-50
• Single line item with bilateral modifier
• Reimbursement typically 150% of unilateral procedure

Scenario 2: Right lumpectomy, left mastectomy

• Code: 19301-RT (right partial mastectomy)
• Code: 19303-LT (left total mastectomy)
• Separate line items for each procedure

ICD-10 Diagnosis Codes

Malignant Neoplasms (C50 Series)

ICD-10 Code	Description	Clinical Application
C50.911	Malignant neoplasm of unspecified site of right female breast	Right breast cancer, site unspecified
C50.912	Malignant neoplasm of unspecified site of left female breast	Left breast cancer, site unspecified
C50.111	Malignant neoplasm of central portion of right female breast	Central/retroareolar right breast cancer
C50.211	Malignant neoplasm of upper-inner quadrant of right female breast	Upper-inner quadrant right breast cancer

In Situ Carcinomas (D05 Series)

• D05.90: Unspecified type of carcinoma in situ of unspecified breast
• D05.10: DCIS, unspecified breast
• D05.11: DCIS, right breast
• D05.12: DCIS, left breast

Benign Conditions (N60 Series)

• N60.01: Solitary cyst of right breast
• N60.02: Solitary cyst of left breast
• N60.11: Diffuse cystic mastopathy of right breast
• N63: Unspecified lump in breast

Real-World Coding Examples

Example 1: Right Breast Cancer with Sentinel Lymph Node

Procedure: Right partial mastectomy with sentinel lymph node biopsy

• Primary Code: 19301-RT (Partial mastectomy, right breast)
• Add-on Code: 38900-RT (Sentinel lymph node biopsy)
• ICD-10: C50.911 (Malignant neoplasm, unspecified site, right female breast)

Example 2: Bilateral Prophylactic Mastectomy

Procedure: Bilateral prophylactic simple mastectomy

• Code: 19303-50 (Bilateral simple mastectomy)
• ICD-10: Z40.01 (Encounter for prophylactic removal of breast)
• Additional: Z15.01 (Genetic susceptibility to malignant neoplasm of breast)

Example 3: Perirectal Abscess Drainage

Procedure: Complex left breast abscess with concurrent right breast biopsy

• Primary Code: 19020-LT (Mastotomy with drainage, left breast)
• Secondary Code: 19100-59-RT (Core needle biopsy, right breast)
• ICD-10: N61.1 (Inflammatory disorder of breast), N63 (Unspecified lump in breast)

Advanced Coding Considerations

Oncoplastic Procedures

When breast conservation surgery includes immediate reconstruction:

• Code primary oncologic procedure (19301)
• Add appropriate reconstruction code (19318-19325)
• Use modifier -58 for staged reconstruction
• Document medical necessity for reconstruction

Margin Re-excision

For positive margins requiring additional excision:

• Same operative session: No additional coding
• Return to OR within global period: Use modifier -78
• Planned staged procedure: Use modifier -58
• Unrelated return: Use modifier -79

Preoperative Localization

Non-palpable lesions requiring localization are coded separately:

• 19281: Placement of breast localization device(s), percutaneous; first lesion
• 19282: Each additional lesion (add-on code)
• 19283: Placement via stereotactic guidance
• 19284: Placement via MRI guidance

Reimbursement and Compliance

National Correct Coding Initiative (NCCI) Edits

Common NCCI edits affecting breast surgery:

• Sentinel lymph node biopsy is bundled with mastectomy codes
• Biopsy and excision of same lesion are mutually exclusive
• Multiple biopsies of same breast may be bundled
• Image guidance is included in localization codes

Quality Payment Program (QPP) Measures

Breast surgery quality measures include:

• Appropriate use of sentinel lymph node biopsy
• Radiation therapy following breast-conserving surgery
• Oncotype DX testing for appropriate patients
• Adjuvant hormonal therapy initiation

Documentation Requirements

Comprehensive operative notes must include:

1. Laterality: Specific breast(s) involved
2. Lesion characteristics: Size, location, palpability
3. Procedure details: Surgical approach, margins assessed
4. Lymph node evaluation: Number of nodes removed, method of identification
5. Specimen handling: Orientation, margin inking, pathology submission
6. Complications: Any intraoperative issues encountered

Expert Tip: When coding bilateral breast procedures, carefully distinguish between truly bilateral procedures (modifier -50) and distinct procedures on separate breasts (anatomic modifiers -RT/-LT). This distinction significantly affects reimbursement patterns.

Accurate breast surgery coding demands meticulous attention to surgical approach, specimen handling, and anatomic considerations. Proper documentation of laterality, lymph node evaluation, and procedural complexity ensures optimal reimbursement while maintaining coding compliance in this complex specialty area.