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See a sample rate comparisonCPT 19294 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.
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
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Integumentary System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 21 - Inpatient Hospital |
| Common Modifiers | None RT - Right side of body LT - Left side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 19294 |
| Medicaid Fee Schedule | View Medicaid rates for 19294 |
National average reimbursement for CPT 19294 by major payers:
$203.91
$220.87
$209.26
$272.29
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CPT 19294
5 of 25 sample ratesHigher to lower in this preview
National Ambulatory Surgery Center, LLC
$1,675.00Published rateHagerstown Surgery Center,LLC
Hagerstown Surgery Center, LLC
$566.00Published rateColumbia Surgical Specialists, Ps, Columbia Surgery Center
Columbia Surgical Specialists, P.S.
$183.00Published rateWhite Oak Surgery Center
$121.00Published rateE. Ronald Salvitti, M.D., Inc., Southwestern PA Eye Surgery Center
E. Ronald Salvitti, M.D., Inc.
$50.00Published rate
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See a sample payer proposalCPT 19294 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 19294 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 19294 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 |
| 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. |
| 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 19294. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 19294 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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