Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy)

CPT 19301 is the billing code for "Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy)". For partial mastectomy including lumpectomy, tylectomy, quadrantectomy, or segmentectomy

Medicare pays approximately $647.25 for CPT 19301 (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 19301 has a total RVU of 27.95, broken down as: Work RVU 12.50, Practice Expense RVU 14.20, and Malpractice RVU 1.25. RVUs (Relative Value Units) determine Medicare reimbursement rates.

Key documentation requirements for CPT 19301 include: Location and size of tumor; Method of localization; Surgical approach and technique; Margins and specimen description. Missing or incomplete documentation is a leading cause of claim denials for this code.

Bundling considerations for CPT 19301: Includes partial mastectomy. Includes wound closure Use an NCCI bundling checker to verify specific code combinations before billing.

Common modifiers for CPT 19301 include: 50 (Bilateral procedure when both sides performed same session), 51 (Multiple procedures performed same session), LT (Left side procedure). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.

The typical time requirement for CPT 19301 is 60-90 minutes typical operative time. Time-based codes require documentation of the actual time spent providing the service.