Biopsy, breast, with placement of breast localization device(s) (e.g., clip, metallic pellet), when performed, percutaneous; first lesion, including magnetic resonance guidance

CPT 19085 is the billing code for "Biopsy, breast, with placement of breast localization device(s) (e.g., clip, metallic pellet), when performed, percutaneous; first lesion, including magnetic resonance guidance". Percutaneous breast biopsy with MRI guidance for first lesion

Medicare pays approximately $711.95 for CPT 19085 (national average). Actual payment varies by geographic location due to GPCI adjustments. Hospital and commercial insurance rates are typically 2-4x higher than Medicare rates.

CPT 19085 has a total RVU of 10.30, broken down as: Work RVU 4.00, Practice Expense RVU 6.00, and Malpractice RVU 0.30. RVUs (Relative Value Units) determine Medicare reimbursement rates.

Key documentation requirements for CPT 19085 include: Location of first lesion documented; MRI guidance documented; Biopsy method documented; Clip placement if performed documented. Missing or incomplete documentation is a leading cause of claim denials for this code.

Bundling considerations for CPT 19085: First lesion only. Includes MRI guidance Use an NCCI bundling checker to verify specific code combinations before billing.

Common modifiers for CPT 19085 include: 59 (Distinct procedural service when multiple procedures performed), 50 (Bilateral procedure), LT (Left side). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.

The typical time requirement for CPT 19085 is Typically 90-120 minutes. Time-based codes require documentation of the actual time spent providing the service.