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See a sample rate comparisonCPT 19125 Fee Schedule
Last Verified: September 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.
Surgery To Remove Breast Lump, Surgery To Remove Abnormal Breast Tissue Or Lump (Lumpectomy) Such As A Cyst (Fluid-Filled Sac) Or Tumor.
| 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 LT - Left side of body RT - Right side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 19125 |
| Medicaid Fee Schedule | View Medicaid rates for 19125 |
National average reimbursement for CPT 19125 by major payers:
$714.65
$692.90
$740.07
$733.56
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CPT 19125
5 of 25 sample ratesHigher to lower in this preview
Melissa Stillberger
University Physicians Incorporated
$2,351.70Published rateBrian Bucca
University Physicians Incorporated
$1,506.02Published rateRichard Milchak
Poudre Valley Medical Group LLC
$926.78Published rateDavid Hamilton
Colorado Springs Orthopaedic Group
$870.53Published rateArizona Digestive Center, P.C.
Arizona Digestive Center PC
$528.00Published rate
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See a sample payer proposalCPT 19125 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 19125 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 19125 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 |
|---|---|---|
| 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) |
| 19294-CPT | Moderate | Preparation Of Tumor Cavity W, Preparation Of Tumor Cavity With Placement Of A Radiation Therapy Applicator For Intraoperative Radiation Therapy (Iort) Concurrent With Partial Mastectomy (List Separately In Addition To Code For Primary Procedure) Tery Disease Data Preparation And Transmission A |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 19125. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 19125 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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