Breast Surgery Payment Information

The following chart provides payment information that is based on the national unadjusted Medicare physician fee schedule for the ultrasound services discussed. Payment will vary by geographic region.

The information provided below is intended to assist providers in determining appropriate codes and the other information for reimbursement purposes. It represents the information available to United Medical Instruments as of January 2012. Subsequent guidance might alter the information provided. United Medical Instruments disclaims any responsibility to update the information provided. It is the provider’s responsibility to determine and submit appropriate codes, modifiers, and claims for the services rendered. Before filing any claims, providers should verify current requirements and policies with the applicable payer.

Breast Surgery Ultrasound and Procedural CPT Codes and Descriptions

Ultrasound Evaluation

2012 Medicare Physician
Fee Schedule
CPT Code
 Code Description Global in Office Allowable
76645 Ultrasound, breast(s) (unilateral or bilateral), real time with image documentation $99.39
76942 Ultrasonic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device), imaging supervision and interpretation $206.61

Procedures

2012 Medicare Physician Fee Schedule 
CPT Code
 Code Description Global in Office Allowable
10022

Fine needle aspiration; with imaging guidance

 $136.83
19000 Puncture aspiration of cyst of breast $109.94
19102 Biopsy of breast, percutaneous, needle core, using imaging guidance $212.05
19103 Biopsy of breast, percutaneous, automated vacuum assisted or rotating biopsy device, using imaging guidance $548.35
19290 Preoperative placement of needle localization wire, breast $159.64
19295 Image guided placement of metallic localization clip or marker during biopsy $91.22
60100 Biopsy, thyroid, percutaneous core needle $110.96


CPT™ five digit codes, nomenclature and other data are Copyright 2010 American Medical Association. All rights reserved. No fee schedules, basic units, relative values or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use.

Deficit Reduction Act of 2005 Adjustment has not been figured into the above global fees.