CPT 19120 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 24 - Ambulatory Surgical Center |
| Common Modifiers | None RT - Right side of body LT - Left side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 19120 |
| Medicaid Fee Schedule | View Medicaid rates for 19120 |
National average reimbursement for CPT 19120 by major payers:
$632.68
$627.26
$677.88
$665.95
CPT 19120 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 19120 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 19120 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 |
|---|---|---|
| 19110-CPT | Moderate | Nipple Exploration With Or Wi, Nipple Exploration With Or Without Excision Of A Solitarylactiferous Duct Or A Papilloma Lactiferous Duct |
| 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 |
| 19125-CPT | Moderate | Surgery To Remove Breast Lump, Surgery To Remove Abnormal Breast Tissue Or Lump (Lumpectomy) Such As A Cyst (Fluid-Filled Sac) Or Tumor. |
| 19126-CPT | Moderate | Excision Addl Breast Lesion, Excision Of Breast Lesion Identified By Preoperative Placement Of Radiological Marker Open; Each Additional Lesion Separately Identified By A Preoperative Radiological Marker (List Separately 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 19120. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 19120 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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