CPT 19126 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 • LT - Left side of body • RT - Right side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 19126 |
National average reimbursement for CPT 19126 by major payers:
$200.67
$210.70
$217.28
$261.42
| 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 19126 | ||||||
United | 19126 | $200.00 | 1639456973 - PHYSICIAN SURGERY CENTER OF ALBUQUERQUE LLC, POSC OF ABQ LLC | 273193930 - (NM) PHYSICIAN SURGERY CENTER OF ALBUQUERQUE LLC | NM | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19126 | $723.00 | 1356480099 - MEMORIALCARE SURGICAL CENTER AT SADDLEBACK LLC | 203678259 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19126 | $71.00 | 1013999580 - INTEG HEALTH SYSTEM, P.C., BLOOMINGTON SURGERY CENTER | 352045236 - (IN) INTEG HEALTH SYSTEM PC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19126 | $555.00 | 1366935074 - SKYWAY SURGERY CENTER, LLC | 813237016 - (FL) SKYWAY SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19126 | $135.00 | 1285664466 - NEWPORT MULTI SPECIALTY SURGERY CENTER LLC | 842619042 - (CA) NEWPORT MULTI SPECIALTY SURGER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19126 | $112.00 | 1932212511 - PALESTINE LASER & SURGERY CENTER PLLC | 470900270 - (TX) PALESTINE LASER SURGERY CENTER PLLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19126 | $70.00 | 1578881009 - EYE LASER AND SURGERY CENTER LLC | 272376757 - (OH) EYE LASER AND SURGERY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19126 | $500.00 | 1376716316 - CPM SURGERY CENTER LLC | 261382311 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19126 | $506.00 | 1962788059 - SURGCENTER OF SILVER SPRING, LLC | 452950933 - (MD) SURGCENTER OF SILVER SPRING LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19126 | $240.00 | 1346213634 - SARASOTA ENDOSCOPY ASC LLC, BAYVIEW ENDOSCOPY CENTER | 621806248 - (FL) THE SARASOTA ENDOSCOPY ASC, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19126 | $225.00 | 1326551623 - UNITED VASCULAR OF OMAHA LLC | 822359316 - (NE) UNITED VASCULAR OF OMAHA LLC | NE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19126 | $555.00 | 1053453134 - ADVANCED SURGICAL CONCEPTS LLC | 331035210 - (LA) ADVANCED SURGICAL CONCEPTS LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19126 | $380.00 | 1174502272 - ENDOSCOPY CENTER OF TOPEKA LP, THE ENDOSCOPY AND SURGERY CENTER OF TOPEKA | 621512368 - (KS) THE ENDOSCOPY CENTER OF TOPEKA L | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19126 | $200.00 | 1386795540 - THE SURGERY CENTER AT LONE TREE, LLC | 260139211 | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 19126 | $39.00 | 1871718270 - PRINCE GEORGES MULTI SPECIALTY SURGERY CENTER | 521842302 - (MD) PRINCE GEORGES MULTI SPECIALTY SURGERY CENTER | MD | 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 19126 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 19126 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 19126 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 |
| 19110-CPT | Moderate | Exploration Nipple |
| 19120-CPT | Moderate | 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 |
| 19126-CPT | Moderate | 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 19126. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 19126 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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