CPT Code 19083: Ultrasound-Guided Breast Biopsy Billing, Bilateral Rules, and 2026 Reimbursement

CPT code 19083 reports a percutaneous breast biopsy performed with real-time ultrasound guidance, covering the first lesion sampled in that session.

You bill from six elements inside the 19083 CPT code description. Each one settles a separate question on the claim.

Two of those rows contradict what most coding references publish. A lesion in each breast doesn’t get two units, and the guidance code many teams append gets stripped by an edit before a human reviewer sees the claim.

Radiology groups, breast imaging centers, breast surgeons, and the billing teams working breast biopsy CPT code claims behind them will find the answers below sourced to the files that govern them.

What CPT Code 19083 Covers, and What the Descriptor Actually Says

The Official AMA Descriptor for 19083

The 19083 CPT code description reads, verbatim from the AMA CPT Professional Edition:

Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including ultrasound guidance.

That language traces back further than most references admit. The AMA Relative Value Scale Update Committee recorded it in its April 2013 minutes, and CMS carried the same wording into the CY 2014 Physician Fee Schedule final rule when the code was valued for payment.

Three clauses carry the billing weight. Percutaneous means needle access through the skin. First lesion means one unit, once per session. Ultrasound guidance means the imaging modality sits inside the code itself.

Billing CPT 19083 off a stereotactic report is the most expensive coding error on a breast claim. No modifier repairs a wrong modality code.

Why “When Performed” Changes How You Read the Code

“When performed” appears twice in that descriptor. It attaches to localization device placement, and it attaches to specimen imaging. Both phrases mean the code covers those steps if they happen. Neither phrase makes them mandatory.

A biopsy done without a clip and without a specimen radiograph is still cpt code 19083. The coder who holds that claim and queries the radiologist has created rework for nothing.

We see the same pattern on new breast imaging accounts. A coder reads “with placement of breast localization device,” assumes the clip is required, pends the claim, and sends a query. The note comes back saying what it said the first time. Three days gone, nothing changed.

So the breast biopsy with clip placement cpt code question has one answer. 19083 covers the clip when the radiologist places one, and 19083 stands on its own when nobody does. The bundling relationships behind that rule are maintained nationally rather than payer by payer, through CMS NCCI for Medicare.

How to Choose Between CPT Codes 19081 to 19086: Guidance Modality Decides the Code

The Guidance Modality Decision Table

The imaging modality used during the procedure determines which of the cpt codes for breast biopsy you report. Pick the wrong one and no modifier fixes it.

A claim built on the wrong modality code can’t be salvaged with an appeal either. You correct the code and resubmit it as a replacement claim.

Stereotactic Biopsy Uses 19081, Not 19083

The cpt code for stereotactic biopsy of breast is 19081 for the first lesion and 19082 for each additional lesion under the same guidance. Same structure as ultrasound, different modality, different code pair.

Coders searching stereotactic breast biopsy cpt code and cpt code 19081 land on 19083 more often than you’d expect, because both codes share an identical descriptor apart from the final clause. The 19081 cpt code description ends with “including stereotactic guidance.” The 19083 version ends with “including ultrasound guidance.” One clause apart.

That single-clause difference is why the stereotactic biopsy breast cpt code gets miscoded on claims that everything else about looks clean. The fix is a read of the last six words before you pick from the family. Anyone verifying a cpt code for stereotactic breast biopsy should check the modality line in the radiology report, not the device the radiologist used.

MRI-Guided Biopsy Uses 19085

Cpt code 19085 covers the first lesion under magnetic resonance guidance, and 19086 covers each additional lesion. The mri guided breast biopsy cpt code selection follows the same first-lesion logic as the rest of the family.

Breast MRI interpretation codes 77046 through 77049 are a separate service and a separate claim question. Our MRI CPT codes guide covers where those sit. Teams searching 19085 cpt code are usually looking for the biopsy code, not the interpretation code.

What Happens When Two Modalities Are Used in One Session

Report another primary code for each additional biopsy performed under a different imaging modality. Not an add-on code. A second primary.

One lesion biopsied under ultrasound and a second lesion biopsied under magnetic resonance in the same session is 19083 and 19085 on the claim. Two primary codes, because two modalities. That rule comes from the AMA new-technology recommendations that established the 19081 to 19086 family in the first place.

The add-on code only applies when the same modality does both lesions. Change the modality and you change back to a primary code.

First Lesion or Additional Lesion: When 19083 Becomes 19084

CPT 19084 Is an Add-On Code and Cannot Be Billed Alone

The 19084 cpt code description defines it as an add-on, which means 19083 has to appear on the same claim before it pays.

NCCI add-on code edits exist so the add-on never pays when the primary isn’t payable. An orphaned cpt 19084 line doesn’t pend for review. It rejects on the spot.

Billing 19083 three times for three lesions doesn’t pay triple. It trips a frequency edit and the second and third lines come back unpaid. You’ve done the same work and collected less than the correct claim would have brought in.

Breast Biopsies Are Coded Per Lesion, Not Per Core

Report cpt code 19083 once per lesion regardless of how many cores the radiologist takes from that lesion. Six passes through one mass is one unit.

The core needle biopsy cpt code question trips people up here because the number of cores feels like it should matter. It doesn’t. Cores describe sampling technique, and the code counts lesions.

What matters operationally is whether the note lets a reviewer count the lesions. A report describing “multiple samples from the 2 o’clock position” documents one lesion, not several. A biller who reads that as two lesions and adds 19084 has built a claim the documentation won’t support on audit.

Ask the reading physician to state lesion count and lesion location once, near the top of the procedure note. That single line removes most of the ambiguity from a cpt code for needle core biopsy of breast claim before the coder ever opens it. Radiologists agree to it because it takes four seconds and stops the queries.

Bilateral Breast Biopsy: Why Two Units of CPT Code 19083 Is the Wrong Claim

The Contralateral Lesion Is an Additional Lesion, Not a Second First Lesion

One lesion in each breast, biopsied under the same guidance in one session, is cpt code 19083 plus 19084.

CPT instruction sends the contralateral biopsy to the add-on code. Which breast the additional lesion sits in changes nothing. The add-on applies as long as the modality stayed the same.

Row three is where most of the field lands wrong.

Why the Bilateral Surgery Indicator Looks Like It Says Otherwise

The MPFS relative value file assigns a bilateral surgery indicator to 19083, and reading it as billing permission is where the split-line claim starts.

That indicator describes how the payment system would handle a bilateral adjustment if one applied. CPT instruction describes the reporting mechanism. The two answer different questions, and the reporting mechanism governs what you put on the claim form.

Apply it this way. Read CPT 19083 guidelines for how to build the claim. Read the indicator for how the claim prices once it’s built. Build from the indicator and you’ll produce two units on two lines, which is the claim that fails in the next section.

Payers see the split-line version constantly. Two lines, 19083 with LT and 19083 with RT, both with clean documentation behind them. The claim looks correct to the person who built it, because every element on it is true. The problem is the units count, and that gets evaluated before anyone reads the documentation.

Modifier 50 Does Not Apply to CPT 19083

Modifier 50 does not belong on a 19083 claim. The contralateral lesion goes to 19084.

The coder reaching for modifier 50 usually came from orthopedics or injection work, where bilateral genuinely means modifier 50 and a 150 percent adjustment. That habit transfers, and it’s wrong on this code family.

Laterality modifiers are a different question, covered further below. Anyone searching cpt code 19083 lt is asking about LT and RT, which some payers do want. Modifier 50 is the one that doesn’t apply here, and our bilateral surgery indicator rules guide explains why modifier 50 doesn’t produce a 150 percent adjustment on every code that carries an indicator.

Commercial payers vary on how they handle a bilateral breast biopsy claim, and a few will accept formats Medicare rejects. Verify the format in your payer rule library before submission rather than after the remit comes back. The CPT instruction is the safe default when a payer hasn’t published anything specific.

Get the 19083 cpt code claim structure right at charge entry and the rest of the bilateral problem disappears.

Why Two Units of the 19083 CPT Code Reject Before Anyone Reviews the Claim

The MUE Sets the Maximum Units Per Date of Service

The Medically Unlikely Edit for cpt code 19083 caps how many units you can report for one patient on one date of service. CMS publishes MUE values quarterly in the NCCI Practitioner Services table, and the current table governs claims for the quarter it covers.

The MUE Adjudication Indicator decides how that cap gets applied, and almost nobody explains this part. An MAI of 1 makes it a claim-line edit. An MAI of 2 or 3 makes it a date-of-service edit, which sums units across every line on the claim before adjudicating.

That distinction is why splitting 19083 across an LT line and an RT line doesn’t defeat the cap. The system adds the lines together first.

One more detail from the NCCI Policy Manual that changes how you plan around this. MUEs are coding edits rather than medical necessity edits, and a claims processing contractor may run a units edit more restrictive than the published MUE value. The published number is a ceiling, not a guarantee.

Frequency Rejections Do Not Respond to Resubmission

The rejection tells you the count was wrong. It doesn’t tell you the coding was wrong, and that distinction costs practices more time than the original error did.

So the biller adjusts the modifier and resubmits. Same rejection. Adjusts the laterality and resubmits. Same rejection. Four touches later the claim is 30 days old and nobody has changed the thing the edit is measuring.

The fix takes one rebuild. One unit of 19083 for the first lesion, 19084 for the contralateral lesion and every additional lesion under the same guidance. That claim clears. The split-line version won’t, on any number of resubmissions, which is a pattern our denial management services team sees on breast imaging accounts before anything else.

Following the cpt code 19083 guidelines on unit counting prevents the whole loop. If your 19083 rejections keep coming back the same way after a resubmission, that’s a pattern rather than a one-off. Patterns are the fixable kind.

Which Modifiers Apply to CPT Code 19083, and Which Ones Do Not

The Complete 19083 Modifier Decision Table

Start with cpt 19083 modifier assignment, because two of the modifiers most often appended to this code are invalid on it.

Several widely-circulated code references list modifier 50, modifier 26, and modifier TC as applicable to this code. All three assignments are wrong, and each one produces a different failure. Modifier 50 conflicts with the add-on instruction. Modifiers 26 and TC assume a component split the code doesn’t have.

Modifiers 26 and TC Do Not Apply to CPT Code 19083

Modifiers 26 and TC do not apply to 19083. The code carries a PC/TC indicator in the MPFS relative value file that tells you whether a code splits into professional and technical components, and this one doesn’t split.

The consequence shows up fast in a split-billing arrangement. An imaging center bills 19083 with TC, the radiologist bills 19083 with 26, and both lines reject because there’s no component to bill separately. Neither party gets paid for work they both did.

LT and RT Are a Payer-by-Payer Question

Laterality on 19083 is a payer question, not a CPT question. Standard CPT guidance doesn’t require a side-specific modifier on this code, and many payers want one anyway for tracking.

Teams searching cpt code 19083 lt are usually mid-claim trying to decide. The answer lives in your payer rule library, not in the coder’s memory. Build the requirement into the scrubber per payer and verify before submission, the same discipline our RT and LT modifier rules guide applies to joint injections.

When Modifier 59 or an X-Modifier Belongs on the Claim

Modifier 59 has a narrow legitimate use on a 19083 claim. A genuinely distinct service, at a distinct site or session, with documentation establishing the distinction.

The real scenario is the separate-lesion lymph node biopsy covered later in this guide, where the guidance question isn’t settled. Everything else that looks like a 59 case on a breast biopsy claim is usually a bundling problem wearing a modifier, and appending 59 to bypass an edit you can’t defend is how a clean account becomes an audit target.

CMS treats the X-modifiers as subsets of 59 and accepts all five. Some commercial payers still prefer 59. Our modifier 59 on secondary studies guide walks the same decision on imaging, and CMS modifier 59 guidance sets the federal standard. The 19083 cpt code rarely needs any of them.

What You Cannot Bill Separately With CPT Code 19083

Ultrasound Guidance 76942 Is Bundled Into 19083

CPT 76942 is not separately reportable with cpt code 19083 for the same lesion. Ultrasound guidance sits inside the 19083 descriptor, so billing it again bills the same service twice.

The CMS NCCI Policy Manual states in Chapter 1 that guidance codes, naming 76942 among them, shall not be reported separately when the guidance is integral to the procedure. That’s the 2026 manual, effective January 1, 2026. The rule isn’t a payer preference and it isn’t regional.

Plenty of published guidance on this question hedges, telling readers that policies vary and some carriers may allow it. They don’t, for the same lesion. The ultrasound guidance cpt code goes on the claim only when it covers something 19083 doesn’t.

The Complete List of Services Bundled Into 19081 to 19086

Every relationship in that table is a national CMS NCCI PTP edit, which means the same pairing fails the same way regardless of payer. Anyone auditing a biopsy cpt code claim against this list can build the block rules in an afternoon. Claim scrubbing before submission turns all seven rows into edits that fire before the claim leaves, and cpt 76098 is the row teams forget most often because the 76098 cpt code description reads like a separate imaging service.

The One Scenario Where Separate Guidance Is Arguable

A core lymph node biopsy performed on a separate lesion under ultrasound guidance in the same session creates a real question. Guidance is bundled into the breast biopsy code. Guidance is not bundled into the lymph node biopsy code. That asymmetry is a legitimate argument for reporting guidance on the separate lesion.

Where it stops being clean: Medicare policy holds that guidance codes get reported once per session rather than once per lesion, and CMS hasn’t published anything addressing a session where guidance is already inside the primary code. The edit can be bypassed with a distinct-service modifier.

Whether your practice carries that risk is a decision for your compliance lead, not your coder. We document the reasoning either way, because an auditor asking about it three years later will want to see the reasoning contemporaneous with the claim.

Clip Placement, Specimen Imaging, and the A4648 Tissue Marker

The Localization Clip Is Included When Placed

Clip and marker placement is included in cpt code 19083 when the radiologist places one. Specimen radiography, reported elsewhere as cpt 76098, is included when performed. Neither gets billed separately, and neither has to happen for the code to be reportable.

Billers field the patient call on this one more than coders do. The marker is a titanium or stainless steel device about the size of a sesame seed, left at the biopsy site so the location shows up on future imaging. For billing purposes it’s a non-event when placed during the biopsy, because the biopsy code already paid for it.

The breast biopsy with clip placement cpt code question comes up because the descriptor mentions the device before it mentions anything else, which makes the clip look like the point of the code.

A4648 Is Not Separately Payable With Breast Biopsy Codes

HCPCS A4648, the implantable tissue marker, is not separately payable when reported with breast biopsy codes 19081 through 19101.

The way this one surfaces is almost always a charge master problem. The supply line is hard-coded to fire on every breast biopsy charge. It denies every time. Nobody traces it because the dollar amount is small enough that it clears the write-off threshold without review, so the same denial posts week after week for years.

We find it during charge master reviews more often than during claim reviews, which means the charge master is the right place to look first. Fixing it at the charge level stops it permanently. Fixing it claim by claim stops it once.

A4648 belongs to the HCPCS Level II set rather than CPT, and the distinction matters for how supply denials get routed. Our HCPCS versus CPT codes guide covers the split.

CPT Codes 19281 to 19288: Localization Device Placement Without a Biopsy

When to Use 19281 to 19288 Instead of CPT Code 19083

The 19281 to 19288 family reports placement of a localization device when no image-guided biopsy happens at that encounter. Perform a biopsy and the device placement falls inside the biopsy code, which takes 19281 to 19288 off the claim entirely.

Four scenarios legitimately use the localization family. A needle localization wire placed before an open surgical biopsy. A clip or radioactive seed placed as a standalone procedure. A device placed after a fine needle aspiration where payer policy permits it. Fiducial marker placement.

These codes count lesions the same way the biopsy codes do. Two bracketing needles placed around a single lesion is one placement, not two, which is where a cpt code breast biopsy with needle localization claim usually goes wrong. Anyone billing a cpt code for needle localized breast biopsy should count the lesions before counting the devices.

The Localization Code Family by Guidance Modality

Cpt code 19281 opens the family, and the structure mirrors the biopsy codes exactly.

One asymmetry in that table explains most of the confusion in this family, and no current reference points it out. The localization codes include a mammographic guidance option. The biopsy codes don’t, because there’s no mammographic-guided biopsy code in CPT at all.

That’s why a coder who learned the biopsy family first assumes cpt 19281 doesn’t exist. Mammographic guidance has no biopsy equivalent, so the pattern they memorized has a gap the localization family fills. Teams searching cpt code 19285 and cpt 19285 are usually trying to reconcile that gap, and the 19281 cpt code description makes it plain once you read it next to 19283.

Within this family the higher modality bundles the lower. Cpt code 19283 bundles mammographic guidance, ultrasound bundles both below it, and magnetic resonance bundles all three. Reporting two modalities for genuinely separate lesions requires a distinct-service modifier on the lower one, and the 19285 cpt code is the row where that comes up most.

Tomosynthesis, Unlisted Code 19499, and Biopsies Without Imaging Guidance

Tomosynthesis-Only Guidance Uses Unlisted Code 19499

The cpt code for tomosynthesis guided breast biopsy depends on whether tomosynthesis worked alone. Report 19081 when a percutaneous breast biopsy uses both stereotactic and tomosynthesis guidance. Report unlisted code 19499 when tomosynthesis is the only guidance used. CMS states both instructions directly in its tomosynthesis breast biopsy article.

Two consequences follow, and billers need both.

Cpt code 19083 and 19084 are not separately payable alongside 19499, because CMS considers them part of the tomosynthesis-guided procedure. The localization codes 19281 through 19288 fall the same way, as the CMS tomosynthesis billing article spells out.

Unlisted codes also require a narrative description on the claim, and the field depends on the form. On a CMS-1500 the description goes in Box 19 on paper, or in the service-line note segment electronically. On a UB-04 it goes in the corresponding facility field. A 19499 claim submitted without that description doesn’t get reviewed and denied. It gets returned, which resets your filing clock without generating a denial you can appeal. Our CMS 1500 form errors guide covers the field placement.

One more rule that catches facilities: a post-biopsy mammogram performed after a tomosynthesis-guided biopsy is part of the procedure and not separately payable. Moving the patient to a different room or a different unit doesn’t change that.

Percutaneous Biopsy Without Imaging Guidance Uses 19100

A percutaneous needle core breast biopsy performed without any imaging guidance is 19100. Open incisional biopsy is 19101. Neither code carries the bundled guidance, localization, or specimen imaging that the 19081 to 19086 family carries, which is why the cpt for breast biopsy selection has to start with the modality question.

Watch the documentation before you land on the 19101 cpt code or on 19100. A note reading “biopsy performed” with no modality named isn’t evidence that nobody used guidance. It’s a documentation gap.

Query it. Coding down to an unguided code on a guided procedure hands back roughly three quarters of the payment, and the query costs you a day.

How Medicare Calculates Payment for CPT Code 19083 in 2026

CY 2026 Has Two Conversion Factors, Not One

Medicare runs two conversion factors starting in CY 2026, one for qualifying APM participants and one for everyone else. Which factor applies to a cpt code 19083 claim depends on the billing provider’s track.

The math underneath hasn’t changed. Add the three RVU components, adjust each by its geographic practice cost index, then multiply by the applicable conversion factor. CMS publishes both factors in the CY 2026 Physician Fee Schedule final rule.

What changed is that one national number no longer describes this code. A group with providers on both tracks can’t hold a single expected-reimbursement value for 19083. Build the fee schedule table on one 2026 conversion factor and roughly half your remittances flag as variances that aren’t variances.

Most rate figures circulating for this code predate that split or ignore it. Four sources give four different numbers and none of them explain the spread, because the spread has a cause nobody is naming.

Where to Pull the Authoritative 19083 Rate

Anyone researching cpt code 19083 reimbursement gets more from the lookup path than from a number that goes stale each quarter.

The CMS Physician Fee Schedule search returns the allowed amount by locality. The RVU file carries the component detail, the PC/TC indicator, the bilateral surgery indicator, and the global period, which covers most of what the rest of this guide references. The National Payment Amount file carries the quarterly refresh.

Rate calculators and code directories republish this data on their own schedule, and the drift starts at that refresh. A cpt code 19083 cost figure pulled from a third-party site in March stops matching your remit by July, and nobody on your team knows why the variance report changed. The CMS PFS look-up tool overview explains how the locality adjustment works before you run the lookup.

Facility Versus Non-Facility Rates for 19083, and Why the Gap Is So Wide

The Practice Expense RVU Is What Moves

The non-facility allowed amount for 19083 runs several times the facility amount, and one RVU component accounts for the whole difference. Work RVU stays identical across both settings. Malpractice RVU stays identical. Practice expense doesn’t.

Look at what the practice owns in an office setting. The ultrasound room. The biopsy device and its single-use probe. The vacuum tubing and canister. The tissue marker. The sonographer standing there for the length of the procedure. CMS prices those direct inputs into the non-facility practice expense RVU.

Move the same procedure into a hospital and the hospital owns all of it, bills for it separately, and the practice expense collapses to almost nothing. The physician did identical work either way.

Multiple procedure payment reduction applies to 19083 as well, which matters in any session where a second reducible procedure runs alongside it. Our MPPR reduction on imaging guide walks the calculation on chest CT, and the same logic applies here.

Place of Service Determines Which Rate Applies

Place of service on the claim decides which rate the payer applies to cpt 19083. POS 11 prices non-facility. POS 22 on-campus hospital outpatient and POS 24 ambulatory surgery center both price facility.

A practice that owns its own ultrasound equipment and submits POS 22 from habit collects the facility rate on a procedure it paid for end to end. No denial fires. The claim posts, reconciles, and closes inside your normal workflow.

Nobody on the team did anything wrong, the claim looks healthy on every report you run, and the money is gone. Our POS 22 hospital outpatient billing guide covers when POS 22 is correct and when it isn’t.

The 19083 Underpayment Nobody Catches

A cpt code 19083 claim priced at the facility rate in an office setting doesn’t reject. It posts, it reconciles, and it closes.

The variance per claim equals the full practice expense differential, which on this code is the largest component in the calculation. A breast imaging center running a modest weekly biopsy volume compounds that across a year, and no denial report shows any of it, because there is no denial to report.

Commercial contracts widen the exposure further. Negotiated rates for 19083 vary by multiples across payers for identical work in an identical setting. A practice that has never benchmarked its contracted 19083 rate against its own remittances has no way to know which end of that spread it sits on.

Catching it requires comparing each posted line against an expected value that reflects the correct place of service and the correct contracted rate, at the moment of posting. The denial queue will never surface it. Line-level underpayment flagging is the only workflow stage where a payment that posted cleanly still gets questioned.

If nobody has benchmarked what your 19083 claims pay against what they should pay, that’s worth twenty minutes. It’s usually the fastest thing to find and the easiest thing to fix once you know the number.

OPPS, ASC, and the Facility Side of a 19083 Claim

Status Indicators Determine Whether the Facility Is Paid Separately

On the facility claim, the OPPS status indicator decides whether 19083 generates its own payment or gets packaged into something else. The primary breast biopsy codes carry a separately payable indicator subject to multiple procedure reduction. The add-on codes carry a packaged indicator, so the facility collects nothing extra for the second lesion.

Run three ultrasound-guided lesions through a hospital outpatient department and the facility payment is structured around one procedure. The professional claim scales with lesion count. The facility claim doesn’t.

A facility budgeting breast biopsy volume off the physician fee schedule will forecast wrong, and the gap widens with every multi-lesion case on the schedule. CMS OPPS payment overview explains how the packaging logic works.

Comprehensive C-Codes for Image-Guided Breast Biopsy

Comprehensive HCPCS C-codes exist for image-guided breast biopsy in the hospital outpatient and ASC setting, covering all lesions in a single code regardless of laterality.

These are facility codes. A physician practice never reports them. An ASC billing team that doesn’t know they exist is constructing claims from the wrong code set entirely, and the shortfall never appears as a denial because the claim they submitted was valid, just incomplete against what they could have billed.

Pull the current code list and rates from the OPPS and ASC addenda rather than from a secondary summary. The CY 2026 OPPS final rule governs both, and the addenda update on a different cadence than the physician fee schedule does.

The 0-Day Global Period and Billing an E/M on the Same Day

Cpt code 19083 carries a 0-day global period. No postoperative period is bundled into the code, and nothing automatically blocks an evaluation and management service on the same date.

The condition is where practices get audited. The E/M has to be significant and separately identifiable from the procedure itself. A pre-procedure discussion of the biopsy you are about to perform is part of the biopsy. An E/M addressing a different problem, or a decision-making encounter that leads to the biopsy and is documented as its own service, stands on its own.

Modifier 25 goes on the E/M code. Not on 19083. Half the claims we see with this problem have the modifier attached to the procedure line, where it does nothing.

Payer policies on same-day E/M with a procedure vary, and some commercial carriers apply edits tighter than Medicare’s. Verify before you bill the combination routinely.

Teams following cpt code 19083 guidelines often assume any procedure code blocks a same-day E/M. A 0-day global says otherwise, and the revenue sitting in that assumption is real. Our 0-day global period rules guide covers the same structure on repair codes.

ICD-10 Codes and Medical Necessity for CPT Code 19083

Commonly Accepted Diagnosis Codes for Breast Biopsy

Coverage runs through the Medicare Administrative Contractor’s local coverage determination for the jurisdiction where the service happened, which means the covered diagnosis for 19083 changes depending on where your practice sits. Commercial payers publish their own lists on top of that.

Laterality on the diagnosis has to match laterality on the claim. A right-breast biopsy coded to an unspecified-laterality lump creates a mismatch that automated edits catch before a human reviewer ever opens the file.

Screening Codes Do Not Support a Diagnostic Biopsy

Z12.31 reports the screening mammogram encounter. It supports a screening study, and it doesn’t support a biopsy of a lesion a prior study already found.

By the time the radiologist is sampling tissue, the encounter is diagnostic. The diagnosis on a 19083 claim should name the finding that prompted the biopsy. Our screening versus diagnostic ICD-10 guide covers the same distinction on lung cancer screening, where the same error produces the same denial.

Which LCD and Coverage Articles Actually Govern

Anyone searching cpt code 19083 lcd runs into the same wall: nobody names the documents. Two CMS articles carry the breast imaging coverage guidance, and a third governs mammography and breast echography.

Start with CMS Billing and Coding: Breast Imaging and the CMS breast imaging LCD article, then confirm which applies in your MAC jurisdiction. Checking cpt 19083 medical necessity against the right article before submission takes a few minutes. Checking it after a CARC 50 costs an appeal cycle.

Same-Day Diagnostic Ultrasound and Same-Session Lymph Node Biopsy

Diagnostic Breast Ultrasound Performed at a Separate Session

A diagnostic breast ultrasound and an ultrasound-guided biopsy performed on the same date at separate sessions raise a question the edit set doesn’t answer cleanly.

The principle holds up. A diagnostic study performed to evaluate a finding, at a distinct encounter, is a different service from the guidance bundled into the biopsy. Whether it survives adjudication depends on whether the documentation establishes two sessions and on the payer’s edit configuration.

The documentation requirement is where these claims fail. Your record has to show two encounters with separate times and separate reports. One report covering both procedures doesn’t establish a separate session, and appending a modifier to a single-report claim doesn’t create one.

Core Lymph Node Biopsy in the Same Session

An ultrasound-guided breast biopsy performed alongside an ultrasound-guided core lymph node biopsy produces a real asymmetry. Guidance sits inside the breast biopsy code. Guidance does not sit inside the lymph node biopsy code. That gap is a legitimate argument for reporting an ultrasound guidance cpt code on the separate lesion.

Where it stays unsettled: Medicare policy holds that guidance codes get reported once per session rather than once per lesion, and CMS has published nothing addressing a session where guidance is already bundled into the primary code. A distinct-service modifier will bypass the edit.

Carrying that risk is a compliance decision, not a coding decision. Document the reasoning at the time you make the call, because an auditor reviewing it three years later will want to see what you knew then.

Why 19083 Claims Get Denied, and How to Recover Them

The 19083 Denial Reference Table

Seven failure modes account for most 19083 cpt code denials, and each one has a defined path back.

Corrected Claim or Appeal: They Are Not the Same Path

Coding and units errors go back as corrected claims. That means a replacement with the right frequency indicator, because a fresh submission of the same claim rejects as a duplicate and buys you another two weeks of nothing.

Medical necessity and coverage denials go to appeal. Those need the imaging report, the procedure note, and the coverage citation attached, and they need someone who can write to the specific LCD language.

Timing decides which of those is still available. The appeal window opens at the denial date, not at the date somebody in your office noticed. A denial sitting unworked for 60 days has spent most of its recoverable life, which is why AR follow-up on aged denials runs on a calendar rather than a queue. Knowing whether to appeal a denied breast biopsy claim or correct it decides whether the money comes back at all.

The Pre-Submission Rules That Prevent the Repeat

Six scrubber rules close most of the table above. Applying the cpt code 19083 guidelines at the edit level costs one afternoon of configuration.

Block 19084 unless 19083 appears on the same claim. Block 76942 and 76098 when either pairs with 19081 through 19086. Cap 19083 units at the current MUE value. Hold the code until the note states a guidance modality. Require laterality where your payer rule library says the payer wants it. Flag POS 22 on any claim from a location that owns its own equipment.

Documentation That Supports a 19083 Claim

Every element in the descriptor needs a matching element in the note. A reviewer is reading for the reasoning behind the procedure, not only the conclusion at the end of it.

A coder cannot infer the guidance modality from the device type or from the room the procedure happened in. The note has to say it.

The most common gap on a 19083 cpt code claim is a note reading “biopsy performed under image guidance” with no modality named, which reviewers see far more often than a missing element. That phrasing is clinically complete and billing-incomplete, and the radiologist writing it has no reason to know the difference.

In most cases it’s the template rather than the physician. Someone built the macro years ago with generic language and every report since has carried it forward. Fix the template once and the query volume on that account drops the same week.

CPT Code 19083 Frequently Asked Questions

What is CPT code 19083?

CPT code 19083 reports a percutaneous breast biopsy performed with real-time ultrasound guidance for the first lesion sampled in a session. The code includes placement of a localization clip when performed, imaging of the biopsy specimen when performed, and the ultrasound guidance itself.

Does CPT 19083 need a modifier?

CPT 19083 doesn’t take a bilateral modifier. Laterality modifiers LT and RT depend on your payer, since some require them and CPT doesn’t. Modifiers 26 and TC don’t apply because the code has no component split. Modifier 59 applies only to a genuinely distinct service with documentation.

What are the modifiers for CPT code 19083?

LT, RT, 59, and the X-modifiers are the ones that can apply, each under narrow conditions. Modifiers 50, 26, TC, and 51 don’t apply to this code at all. Modifier 25 applies to a same-day E/M, and it goes on the E/M line rather than on 19083.

How do you bill a bilateral breast biopsy with 19083?

Report one unit of 19083 for the first lesion and 19084 for the lesion in the opposite breast. CPT treats the contralateral lesion as an additional lesion when the same guidance modality covers both. Two units of 19083 and modifier 50 are both incorrect on this code.

Can you bill 76942 with CPT 19083?

No, for the same lesion. Ultrasound guidance is written into the 19083 descriptor, so reporting 76942 alongside it bills the same service twice. The CMS NCCI Policy Manual states that guidance codes including 76942 shall not be reported separately when the guidance is integral to the procedure.

How many units of the 19083 CPT code can be billed per day?

The Medically Unlikely Edit sets the maximum units of service for one patient on one date of service, and CMS publishes the value quarterly. Splitting 19083 across an LT line and an RT line doesn’t get around a date-of-service edit, because the system totals the lines before adjudicating.

Does CPT 19083 have a global period?

CPT 19083 carries a 0-day global period, so no postoperative period is bundled into the code. A significant, separately identifiable evaluation and management service performed the same day is billable with modifier 25 appended to the E/M code. Payer policies on that combination vary.

How much does Medicare pay for CPT 19083?

The non-facility rate exceeds the facility rate because the practice expense RVU covers equipment, supplies, and staff time the practice owns. CY 2026 introduced two conversion factors depending on APM participation, so pull your locality rate from the CMS Physician Fee Schedule look-up tool.

What ICD-10 codes support CPT 19083?

Diagnoses from the N63, N60, R92, C50, and D05 families commonly support the procedure. The covered list is set by your MAC’s local coverage determination and varies by jurisdiction, and anyone checking cpt code 19083 lcd requirements should verify the article that applies to them. A screening code doesn’t support a diagnostic biopsy.

What is the difference between 19083 and 19081?

Guidance modality is the only difference. 19083 covers ultrasound-guided biopsy of the first lesion and 19081 covers stereotactic guidance, and the descriptors are otherwise identical. A claim built on the wrong modality code has to be corrected and resubmitted, since no modifier reconciles the code to the report.

How ClaimMax RCM Handles Breast Imaging Claims

Written by the coding and compliance team at ClaimMax RCM medical billing, a California-based revenue cycle company working breast biopsy cpt code claims, diagnostic imaging, and interventional radiology accounts across all 50 states. Our coders hold AAPC certification and work radiology denials daily rather than occasionally.

A cpt code 19083 claim clears on first pass when six things line up. The modality code matches the guidance the radiologist documented. The lesion count uses the add-on where the add-on belongs. No guidance or specimen imaging line rides along beside it. Laterality appears where the payer wants it. The diagnosis comes off the coverage article that governs your jurisdiction. The rate table is configured for the place of service where the procedure happened.

Miss one and the claim either denies or underpays. Miss the last one and it underpays without ever telling you.

Breast imaging claims fail in a narrow set of ways, and the same three or four keep showing up across accounts. If your 19083 denials look like a pattern rather than one-offs, we can usually tell you which pattern in about twenty minutes. Our end-to-end revenue cycle management work starts with that conversation.