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 |
| Medicare Fee Schedule | View Medicare rates for 19086 |
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 | $566.00 | 1790344182 - BRISTOL AMBULATORY SURGERY CENTER, LLC | 834345983 | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19086 | $343.00 | 1861487324 - DOCTORS PARK SURGERY INC | 431608281 - (MO) DOCTORS PARK SURGERY, INC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19086 | $594.00 | 1528142726 - GENORTHO, LLC, CROW VALLEY ORTHOPAEDIC SURGERY CENTER | 203406994 - (IA) GENORTHO LLC | IA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19086 | $200.00 | 1609882810 - LAGRECA EYE CLINIC PC, THE EYE CLINIC SURGICENTER LAGRECA EYE CLINIC | 320016290 - LAGRECA EYE CLINIC, PC | MT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19086 | $275.00 | 1609983477 - NORTH GEORGIA ENDOSCOPY CENTER INC | 582070246 | 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 | $121.00 | 1760773949 - PIEDMONT OUTPATIENT SURGERY CENTER, LLC | 273982668 - (NC) PIEDMONT OUTPATIENT SURGERY CENTER LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19086 | $4613.00 | 1336180173 - BELTWAY SURGERY CENTERS LLC | 352072586 | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19086 | $458.00 | 1639135346 - SURGERY CENTERS OF DES MOINES LTD | 363562598 | IA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19086 | $555.00 | 1962714154 - SURGCENTER OF WHITE MARSH, LLC | 272873637 - (MD) SURGCENTER OF WHITE MARSH, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19086 | $962.54 | 1578208435 - NPI SURGERY CENTER LLC | 852578527 - (NE) NPI SURGERY CENTER LLC | NE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19086 | $234.00 | 1629142666 - ENDOSCOPY CENTER OF BUCKS COUNTY, LP | 841693856 - (PA) ENDOSCOPY CENTER OF BUCKS COUNTY LP | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19086 | $106.00 | 1306199757 - SONTERRA PROCEDURE CENTER, LLC | 455125802 - (TX) SONTERRA PROCEDURE CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19086 | $170.00 | 1568950996 - HOLLYWOOD REGIONAL SURGERY CENTER LLC | 825140248 - (FL) HOLLYWOOD REGIONAL SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19086 | $144.00 | 1013980317 - LOS ANGELES-INGLEWOOD ENDOSCOPY LP, AIRPORT ENDOSCOPY CENTER | 621814135 - (CA) LOS ANGELESINGLEWOOD ENDOSCOPY LP | CA | 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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