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See a sample rate comparisonCPT 19499 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
Breast Procedure, Surgery Involving The Breast And Surrounding Tissue Or Structures.
| 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 | High |
| Medicare Fee Schedule | View Medicare rates for 19499 |
| Medicaid Fee Schedule | View Medicaid rates for 19499 |
National average reimbursement for CPT 19499 by major payers:
$1,061.60
$275.15
$320.43
$1,403.86
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CPT 19499
5 of 25 sample ratesHigher to lower in this preview
Hospital For Special Surgery West Side Ambulatory Surgery Center, LLC, Hss West Side Asc, LLC
$7,336.00Published rateWatsonville Surgeons Group LLC, Central Coast Surgery Center
Watsonville Surgeon'S Group Inc
$1,700.00Published rateJ. Graff Surgery Center Inc, Willow Bend Surgery Center Of Plano
J Graff Surgery Center Inc
$1,321.00Published rateMillman-Derr Center For Eye Care, P.C., Md Surgicenter
Millman-Derr Center For Eye Care, P.C.
$989.00Published rateTampa Bay Specialty Surgery Center LLC, Tampa Bay Specialty Surgery Center
Tampa Bay Specialty Surgery Center LLC
$504.00Published rate
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See a sample payer proposalCPT 19499 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 19499 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 19499 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 |
|---|---|---|
| 11970-CPT | Moderate | Skin Prosthesis Placement, Surgery To Place A Permanent Prosthesis (Structure) Where A Tissue Expander Has Been Used To Prepare Tissue To Accept The Prosthesis. |
| 15777-CPT | Moderate | Implantation Of Biologic Implant (Eg Acellular Dermal Matrix) For Soft Tissue Reinforcement (Ie Breast Trunk) (List Separately In Addition To Code For Primary Procedure) (Revised 01/01/2014) |
| 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. |
| 19499-CPT | High | Breast Procedure, Surgery Involving The Breast And Surrounding Tissue Or Structures. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 19499. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 19499 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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