Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonCPT 19101 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 | 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 19101 |
| Medicaid Fee Schedule | View Medicaid rates for 19101 |
National average reimbursement for CPT 19101 by major payers:
$399.61
$425.14
$437.77
$366.51
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 19101.
CPT 19101
5 of 25 sample ratesHigher to lower in this preview
Surgicenter Of Kansas City, LLC
$3,273.00Published rateSurgery Center Of Scottsdale, LLC, Mountain View Surgery Center Of Phoenix
Surgery Center Of Scottsdale LLC
$1,816.00Published rateMaryland Endoscopy Center LLC, Maryland Endoscopy Center
Maryland Endoscopy Center, LLC.
$858.00Published rateCedar Medical Specialties, PLLC, Cedar Laser And Surgery Center
Aesthetic Surgery Centre, PLLC
$588.00Published rateMelissa Eisenhauer
Deaconess Hospital Inc
$267.32Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 19101 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 19101 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 19101 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 |
|---|---|---|
| 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. |
| 19120-CPT | Moderate | Removal Of Breast Lesion, Excision Of Cyst Fibroadenoma Or Other Benign Or Malignant Tumor Aberrant Breast Tissue Duct Lesion Nipple Or Areolar Lesion Except 19300 Open Male Or Female 1 Or More Lesions |
| 19301-CPT | Moderate | Removal Of Part Of A Breast, Surgery To Remove A Single Lump Or A Portion Of The Breast Tissue (Partial Mastectomy). Nearby Lymph Nodes Also May Be Removed. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 19101. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 19101 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.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 19101) and we'll show you how you compare in 15 minutes or less.