CPT 19086 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Surgery • Surgical Procedures on the Integumentary System |
| Common Place of Service | • 22 - On Campus Outpatient Hospital • 11 - Office |
| Common Modifiers | • None • LT - Left side of body • RT - Right side of body |
| Complexity Level | Moderate |
National average reimbursement for CPT 19086 by major payers:
$748.19
$988.36
$914.18
$1,152.34
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 19086 | ||||||
United | 19086 | $574.00 | 1194723981 - GREENWOOD ASC LLC, GREENWOOD AMBULATORY SURGERY CENTER | 331021175 - (CO) GREENWOOD ASC LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19086 | $1125.00 | 1295381572 - SOUTH SUBURBAN SURGICAL SUITES, LLC, SOUTH SUBURBAN SURGICAL SUITES | 842207819 - (IN) SOUTH SUBURBAN SURGICAL SUITES LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19086 | $500.00 | 1215275227 - ISPM ASC AT PIEDMONT, LLC | 455109249 - (GA) ISPM ASC AT PIEDMONT LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19086 | $109.00 | 1083124366 - KENTUCKIANA PAIN SPECIALIST AMBULATORY SURGERY CENTER, KPS AMBULATORY SURGERY CENTER | 823254465 - (KY) KENTUCKIANA PAIN SPECIALIST AMBULATORY SURGERY CENTER | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19086 | $555.00 | 1285815522 - TLC ASC, LLC, KZMSS AGAIN, LLLP | 201952603 - (FL) TLC ASC LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19086 | $75.00 | 1083624225 - UNIVERSITY OF MARYLAND SURGCIAL ASSOC PA, UNIVERSITY OF MARYLAND UROLOGICAL SURGERY CENTER | 521557551 - (MD) UNIVERSITY OF MARYLAND SURGICAL ASSOCIATES P A | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19086 | $175.00 | 1487014361 - GRIFFIN CENTER FOR PAIN AND SPINE | 814348805 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19086 | $173.00 | 1619071214 - RADS OF AMERICA, LLC, PREMIER RADIOLOGY PAIN MANAGEMENT CENTER | 200597581 - (TN) RADS OF AMERICA LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19086 | $418.00 | 1164584066 - NAPERVILLE SURGICAL CENTRE LLC | 200433367 - (IL) NAPERVILLE SURGICAL CENTRE, LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19086 | $1081.00 | 1710231642 - ADVANCED REGIONAL SURGERY CENTER, LLC | 461072979 - (IN) ADVANCED REGIONAL SURGERY CENTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19086 | $2666.00 | 1477594422 - SURGERY CENTER OF AVENTURA LTD | 113765789 - (FL) SURGERY CENTER OF AVENTURA LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19086 | $150.00 | 1265404669 - NORTH RIVER SURGERY CENTER, LLC | 710799771 - (AR) NORTH RIVER SURGERY CENTER LLC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19086 | $566.00 | 1366406233 - MIDDLE TENNESSEE AMBULATORY SURGERY CENTER, L.P. | 621699667 - (TN) MIDDLE TENNESSEE AMBULATORY SURGERY CENTER LP | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19086 | $476.00 | 1124125331 - AMBULATORY SURGERY ASSOCIATES, LLC, BROOKSIDE SURGERY CENTER | 383237596 - (MI) AMBULATORY SURGERY ASSOCIATES | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19086 | $200.00 | 1972853810 - UNIVERSITY OF HOUSTON SYSTEM, UH COLLEGE OF OPTOMETRY SURGERY CENTER | 746001399 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 19086 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 19086 code is part of the Surgery services used for Surgical Procedures on the Integumentary System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 19086 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 19083-CPT | Moderate | 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 |
| 19084-CPT | Moderate | Biopsy Breast With Placement Of Breast Localization Device(S) (Eg Clip Metallic Pellet) When Performed And Imaging Of The Biopsy Specimen When Performed Percutaneous; Each Additional Lesion Including Ultrasound Guidance(List Separately In Addition To Code For Primary Procedure) |
| 19085-CPT | Moderate | 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 Magnetic Resonance Guidance |
| 19086-CPT | Moderate | Biopsy Breast With Placement Of Breast Localization Device(S) (Eg Clip Metallic Pellet) When Performed And Imaging Of The Biopsy Specimen When Performed Percutaneous; Each Additional Lesion Including Magnetic Resonance Guidance(Listseparately In Addition To Code For Primary Procedure) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 19086. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 19086 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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