Mastectomy, modified radical, including axillary lymph nodes, with or without pectoralis minor muscle

CPT 19307 is the billing code for "Mastectomy, modified radical, including axillary lymph nodes, with or without pectoralis minor muscle". For modified radical mastectomy removing entire breast and axillary lymph nodes

Medicare pays approximately $1155.09 for CPT 19307 (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 19307 has a total RVU of 45.35, broken down as: Work RVU 20.50, Practice Expense RVU 22.80, and Malpractice RVU 2.05. RVUs (Relative Value Units) determine Medicare reimbursement rates.

Key documentation requirements for CPT 19307 include: Indication for mastectomy; Extent of axillary node dissection; Number of nodes removed; Pectoralis minor muscle handling. Missing or incomplete documentation is a leading cause of claim denials for this code.

Bundling considerations for CPT 19307: Includes complete mastectomy. Includes axillary node dissection Use an NCCI bundling checker to verify specific code combinations before billing.

Common modifiers for CPT 19307 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 19307 is 90-120 minutes typical operative time. Time-based codes require documentation of the actual time spent providing the service.