Mastectomy, simple, complete

CPT 19303 is the billing code for "Mastectomy, simple, complete". For complete simple mastectomy removing entire breast without axillary node dissection

Medicare pays approximately $940.31 for CPT 19303 (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 19303 has a total RVU of 34.88, broken down as: Work RVU 15.80, Practice Expense RVU 17.50, and Malpractice RVU 1.58. RVUs (Relative Value Units) determine Medicare reimbursement rates.

Key documentation requirements for CPT 19303 include: Indication for mastectomy; Surgical approach and technique; Extent of tissue removal; Any complications. Missing or incomplete documentation is a leading cause of claim denials for this code.

Bundling considerations for CPT 19303: Includes complete mastectomy. Includes wound closure Use an NCCI bundling checker to verify specific code combinations before billing.

Common modifiers for CPT 19303 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 19303 is 75-105 minutes typical operative time. Time-based codes require documentation of the actual time spent providing the service.