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See a sample rate comparisonCPT 19100 Fee Schedule
Last Verified: October 2026
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.
Breast Biopsy, A Procedure To Remove A Sample Of Tissue From A Breast For Testing. Ultrasound (Sound Wave Images) May Be Used To Help Locate The Tissue To Be Sampled. The Sample May Be Taken In Surgery Or With A Needle.
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Integumentary System |
| Common Place of Service | 11 - Office 22 - On Campus Outpatient Hospital |
| Common Modifiers | None LT - Left side of body RT - Right side of body |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 19100 |
| Medicaid Fee Schedule | View Medicaid rates for 19100 |
National average reimbursement for CPT 19100 by major payers:
$177.06
$189.44
$196.63
$123.91
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CPT 19100
5 of 25 sample ratesHigher to lower in this preview
Froedtert Surgery Center, LLC
$1,838.00Published rateSt. Joseph'S Outpatient Surgery Center, LLC
St Josephs Outpatient Surgery Center LLC
$1,276.00Published rateAmbulatory Surgery Center Of Centralia
$812.00Published rateBeltline Surgery Center, LLC
Beltline Surgery Center LLC
$536.02Published rateJohn Burnley
Deaconess Hospital Inc
$260.76Published rate
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See a sample payer proposalCPT 19100 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 19100 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 19100 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 | Bx Breast 1st Lesion Us Imag, 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 |
| 19085-CPT | Moderate | Bx Breast 1st Lesion Mr Imag, 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 |
| 19100-CPT | Low | Breast Biopsy, A Procedure To Remove A Sample Of Tissue From A Breast For Testing. Ultrasound (Sound Wave Images) May Be Used To Help Locate The Tissue To Be Sampled. The Sample May Be Taken In Surgery Or With A Needle. |
| 19101-CPT | Moderate | Breast Biopsy, A Procedure To Remove A Sample Of Tissue From A Breast For Testing. Ultrasound (Sound Wave Images) May Be Used To Help Locate The Tissue To Be Sampled. The Sample May Be Taken In Surgery Or With A Needle. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 19100. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 19100 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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