{"id":177224,"date":"2026-08-13T10:16:40","date_gmt":"2026-08-13T10:16:40","guid":{"rendered":"https:\/\/pabau.com\/?p=177224"},"modified":"2026-08-13T13:14:25","modified_gmt":"2026-08-13T13:14:25","slug":"cpt-code-19020","status":"publish","type":"post","link":"https:\/\/pabau.com\/de\/procedure-codes\/cpt-code-19020\/","title":{"rendered":"CPT code 19020: Mastotomy with exploration or drainage of abscess"},"content":{"rendered":"\n<script type=\"application\/ld+json\">{\"@context\":\"https:\/\/schema.org\",\"@type\":\"MedicalWebPage\",\"headline\":\"CPT code 19020: Mastotomy with exploration or drainage of abscess\",\"description\":\"CPT code 19020 covers mastotomy with exploration or drainage of a deep breast abscess. See the clinical indications, ICD-10 pairings, modifiers, the 90-day global period, and 2026 Medicare rates.\",\"url\":\"https:\/\/pabau.com\/procedure-codes\/cpt-code-19020\/\",\"audience\":{\"@type\":\"MedicalAudience\",\"audienceType\":\"Clinician\"},\"reviewedBy\":{\"@type\":\"Person\",\"name\":\"Dr Vanja Kitanova\",\"jobTitle\":\"Medical Reviewer\",\"affiliation\":{\"@type\":\"Organization\",\"name\":\"Pabau\"},\"knowsAbout\":[\"Medical Coding\",\"Clinical Documentation\",\"Healthcare Billing\",\"Clinical Safety\"],\"sameAs\":\"https:\/\/pabau.com\/blog\/author\/vanja\/\"},\"datePublished\":\"2026-08-07\",\"dateModified\":\"2026-08-13\"}<\/script>\n\n\n        <div id=\"key_takeaways\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/12\/Key-Takeaways-Icon.svg\" alt=\"Key takeaways\" height=\"42\" width=\"42\">\n                                <h3>Key takeaways<\/h3>\n            <\/div>\n            <div class=\"list\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>CPT code 19020 covers mastotomy with exploration or drainage of a deep breast abscess, reached through breast tissue.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Medicare treats 19020 as a major procedure with a 90-day global period, so routine follow-up care is already paid for.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>The 2026 national average pays roughly $514 in an office setting and roughly $316 in a facility.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Depth, laterality, and a documented abscess all have to appear in the record before the claim goes out.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Practice management software like Pabau keeps the operative note, diagnosis codes, and invoices on one patient record.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<p class=\"wp-block-paragraph\">CPT code 19020 covers mastotomy with exploration or drainage of a deep breast abscess. The surgeon opens the breast, works through the tissue, and drains a collection that antibiotics could not clear.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Two words in the descriptor decide whether the claim pays. The first is deep, the second is exploration. When the operative note skips them, a payer reads the service as skin-level drainage and reimburses it that way.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Medicare also treats 19020 as major surgery, with a 90-day global period attached. That one fact changes how you bill every follow-up visit for the next three months.<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe title=\"CPT Coding Pitfalls Every Medical Practice Faces\" width=\"800\" height=\"450\" src=\"https:\/\/www.youtube.com\/embed\/vbvV5okdXKg?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<h2 id=\"h-what-cpt-code-19020-covers-and-what-deep-means\" class=\"wp-block-heading\">What CPT code 19020 covers, and what deep means<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">19020 is the breast-specific incision code for a deep abscess. The official descriptor from the <a href=\"https:\/\/www.ama-assn.org\/practice-management\/cpt\/cpt-code-set-overview\" target=\"_blank\" rel=\"nofollow noopener\">American Medical Association<\/a> reads <strong>mastotomy with exploration or drainage of abscess, deep<\/strong>. In the code set it sits in the Surgery section, under Breast, in the Incision category.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Depth is the whole test. The code applies when a surgeon cuts through breast parenchyma to reach a collection below the superficial tissue planes. Drainage at or near the skin surface belongs to the integumentary codes instead.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Practices billing <a href=\"https:\/\/pabau.com\/industry\/plastic-surgery-emr\/\">plastic surgery<\/a> or breast surgical services usually meet 19020 after antibiotic treatment has already failed.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Field<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Value<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">CPT code<\/td>\n<td style=\"padding:12px 16px;color:#374151\">19020<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Full descriptor<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Mastotomy with exploration or drainage of abscess, deep<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">CPT section<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Surgery<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Subsection<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Breast<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Category<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Incision<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Procedure type<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Surgical, open incision through deep tissue<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Global period<\/td>\n<td style=\"padding:12px 16px;color:#374151\">90 days, a major surgical procedure<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<h2 id=\"h-what-the-surgery-involves-and-what-the-note-must-say\" class=\"wp-block-heading\">What the surgery involves, and what the note must say<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The procedure is short, yet the note has to carry more detail than the surgery takes. Anesthesia follows the abscess depth and the patient&#8217;s tolerance, so some cases run under local with sedation and others need general.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">From there the sequence is consistent. The surgeon incises the skin, dissects through breast parenchyma, and opens the abscess cavity. Drainage and irrigation follow, and many cavities are packed rather than closed, so the infection cannot seal itself back in.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Exploration matters for coding as much as drainage does. When a surgeon opens the breast to judge the extent of infection and finds no discrete abscess, 19020 still stands. Both halves of that work belong in the note, so <a href=\"https:\/\/pabau.com\/blog\/clinical-documentation-software\/\">clinical documentation<\/a> templates that prompt for depth and drainage earn their keep.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Incision depth:<\/strong> Through breast parenchyma, not limited to subcutaneous tissue<\/li>\n\n\n\n<li><strong>Anesthesia:<\/strong> Local with sedation or general, named in the operative note<\/li>\n\n\n\n<li><strong>Cavity management:<\/strong> Irrigation, packing, or placement of a drain<\/li>\n\n\n\n<li><strong>Closure:<\/strong> Often left open or loosely approximated to allow continued drainage<\/li>\n\n\n\n<li><strong>Exploration:<\/strong> Billable even when no discrete abscess is found, provided the indication is documented<\/li>\n<\/ul>\n\n\n\n<h2 id=\"h-when-19020-is-the-right-call\" class=\"wp-block-heading\">When 19020 is the right call<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Use 19020 when the infection sits deep in the breast and conservative care has failed. Three presentations account for most of these cases.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Deep breast abscess:<\/strong> A walled-off collection inside breast parenchyma, usually confirmed on ultrasound, where needle aspiration failed or was never feasible.<\/li>\n\n\n\n<li><strong>Mastitis that antibiotics did not clear:<\/strong> Infectious mastitis that has progressed to an abscess. For a breastfeeding patient, O91.13 is the precise diagnosis, and the note needs to show abscess formation rather than mastitis alone.<\/li>\n\n\n\n<li><strong>Postoperative wound infection:<\/strong> A deep infection after augmentation, reduction, or reconstruction that needs open exploration. If an intact implant has to come out, code that removal separately as <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-19328\/\">19328<\/a>.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">In <a href=\"https:\/\/pabau.com\/industry\/obgyn-emr-software\/\">obstetrics and gynecology practices<\/a>, most of these abscesses arrive in the weeks after delivery. Wherever the patient comes from, the note has to tie the presentation to the depth of the work. A chart that says only &#8222;breast abscess&#8220;, with no depth, no imaging, and no failed conservative care, invites a denial.<\/p>\n\n\n\n<h2 id=\"h-icd-10-codes-that-carry-the-medical-necessity\" class=\"wp-block-heading\">ICD-10 codes that carry the medical necessity<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">N61.1 is the workhorse diagnosis for a non-puerperal breast abscess. The table below pairs the common presentations with the codes payers expect to see. Treat it as a coding reference, then confirm the pairing against your payer&#8217;s coverage policy.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">ICD-10 code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Description<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Clinical scenario<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">N61.1<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Abscess of the breast and nipple<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Primary deep breast abscess needing open drainage<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">O91.13<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Abscess of breast associated with lactation<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Breastfeeding patient whose abscess did not respond to antibiotics<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">O91.12<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Abscess of breast associated with the puerperium<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Postpartum abscess where the record does not document lactation<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">N61.0<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Mastitis without abscess<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Infection with no abscess documented, and not enough on its own for 19020<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">T81.42XA<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Infection following a procedure, deep incisional surgical site, initial encounter<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Deep wound infection after earlier breast surgery<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Lactation and the puerperium are not interchangeable here. O91.13 names lactation directly, so it fits the breastfeeding patient better than O91.12 does. For a postoperative infection, T81.42XA already carries the depth in its description, and the seventh character A marks the initial encounter.<\/p>\n\n\n\n<h2 id=\"h-modifiers-that-keep-a-19020-claim-clean\" class=\"wp-block-heading\">Modifiers that keep a 19020 claim clean<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Laterality is the modifier you can count on needing. The others depend on what else happened in the operating room that day.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Modifier<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Description<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">When to apply<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">LT<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Left side<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Drainage performed on the left breast only<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">RT<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Right side<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Drainage performed on the right breast only<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">50<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Bilateral procedure<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Both breasts drained in the same operative session<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">22<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Increased procedural services<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Work well beyond the norm, such as a multiloculated abscess, with a note that proves it<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">51<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Multiple procedures<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Another procedure in the same session, with the modifier on the secondary code<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">59<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Distinct procedural service<\/td>\n<td style=\"padding:12px 16px;color:#374151\">A separate site or session from another billed code, where an edit would otherwise bundle the two<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Most payers require LT or RT on any procedure performed on a paired structure. A 19020 claim without one often comes back as a request for information rather than a payment. Before you pair 19020 with another surgical code in the same session, check the <a href=\"https:\/\/www.cms.gov\/medicare\/coding-billing\/national-correct-coding-initiative-ncci-edits\" target=\"_blank\" rel=\"nofollow noopener\">NCCI edits<\/a>.<\/p>\n\n\n        <div id=\"pro_tip\">\n            <div class=\"img\">\n                <svg width=\"42\" height=\"42\" viewBox=\"0 0 42 42\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M12.6383 19.5238C12.6632 21.2071 12.8734 22.9926 12.0685 24.5523C11.0341 26.8917 8.45076 28.169 7.56292 30.5918C6.63082 33.1061 7.19505 36.185 9.31371 37.9786C10.929 39.5678 13.4183 39.9873 15.6061 39.5463C17.4592 39.073 19.1049 37.8388 19.9706 36.1608C20.781 34.7141 20.7866 32.9904 20.5293 31.3985C20.1006 29.3092 18.3775 27.8705 16.9807 26.362C14.8814 24.1005 14.6684 20.6854 15.595 17.8915C16.4331 15.4768 19.0026 14.2344 20.0425 11.9461C20.7202 10.6769 20.7506 9.20327 20.6068 7.81304C20.1864 5.40098 18.3139 3.23631 15.8716 2.56674C13.9742 2.03969 11.8224 2.30052 10.1739 3.37614C8.70522 4.34688 7.5878 5.86618 7.28356 7.58178C6.76081 9.82981 7.53525 12.2822 9.20307 13.9118C10.7658 15.4741 12.4806 17.2273 12.6383 19.5238Z\"\n                        fill=\"#2BADD4\" \/>\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M22.7048 19.8387C22.6822 22.3279 24.4507 24.6234 26.7493 25.4682C28.0531 25.961 29.4725 25.9183 30.7989 25.5487C32.0575 24.9955 33.301 24.2237 34.0069 23.0092C34.8384 21.5811 35.2982 19.8286 34.7832 18.2094C34.3611 16.2507 32.8739 14.6541 31.0275 13.9426C28.6736 12.9595 25.8073 13.7942 24.1719 15.7001C23.2022 16.8366 22.6143 18.3326 22.7048 19.8387Z\"\n                        fill=\"#2BADD4\" \/>\n                <\/svg>\n            <\/div>\n            <div class=\"text\">\n                <h3>Pro Tip<\/h3>\n                <p>Record the side, left or right, in the operative note and on the claim line before submission. Missing laterality is one of the most common reasons breast surgery claims come back. Make it a required field in your pre-claim check.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-what-medicare-pays-for-cpt-19020-in-2026\" class=\"wp-block-heading\">What Medicare pays for CPT 19020 in 2026<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Medicare&#8217;s 2026 national average runs about $514 in the office and about $316 in a facility. The <a href=\"https:\/\/www.cms.gov\/medicare\/physician-fee-schedule\/search\/overview\" target=\"_blank\" rel=\"nofollow noopener\">CMS Physician Fee Schedule<\/a> sets both figures, then geographic cost indices adjust them for your locality.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Rate type<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">2026 national average<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Notes<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Non-facility rate<\/td>\n<td style=\"padding:12px 16px;color:#374151\">$490 to $540<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Office or freestanding practice, POS 11, where you carry the supply and staff costs<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Facility rate<\/td>\n<td style=\"padding:12px 16px;color:#374151\">$300 to $330<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Hospital outpatient or surgery center, POS 22 or 24, where the facility bills its own overhead<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Treat those as planning figures. Rates move every January, so pull your own locality&#8217;s amount from the fee schedule lookup before you build a fee schedule or quote a patient.<\/p>\n\n\n\n<h3 id=\"h-why-the-place-of-service-changes-the-check\" class=\"wp-block-heading\">Why the place of service changes the check<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">The place-of-service code decides which rate applies. Bill POS 11 and Medicare pays the non-facility rate, because your practice absorbs the room, supplies, and staff time. Use POS 22 or 24 and the hospital or surgery center bills that overhead, so the physician payment drops.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">One error shows up again and again. A claim goes out with POS 11 after the surgery actually happened in a hospital outpatient department, which creates an overpayment and an audit flag. Check the POS against the location in the operative note every time.<\/p>\n\n\n\n<h2 id=\"h-how-the-rvus-build-that-payment\" class=\"wp-block-heading\">How the RVUs build that payment<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">19020 carries 3.73 work RVUs. Practice expense and malpractice bring the total to 15.40 in the office and 9.47 in a facility. That difference is why the two payment rates diverge.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">RVU component<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">2026 value<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">What it reflects<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Work RVU<\/td>\n<td style=\"padding:12px 16px;color:#374151\">3.73<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Physician time, skill, and stress, the same in either setting<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Total RVU, non-facility<\/td>\n<td style=\"padding:12px 16px;color:#374151\">15.40<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Adds the practice expense you carry when the work happens in your office<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Total RVU, facility<\/td>\n<td style=\"padding:12px 16px;color:#374151\">9.47<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Lower practice expense share, since the facility bills its own costs<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Multiply either total by the 2026 conversion factor of roughly $33.40 and you land on the payment amounts above. Values shift with each fee schedule final rule, so check the current year in the <a href=\"https:\/\/www.aapc.com\/codes\/cpt-codes-range\/\" target=\"_blank\" rel=\"nofollow noopener\">AAPC code lookup<\/a> before you quote a figure.<\/p>\n\n\n\n<h2 id=\"h-the-90-day-global-period-changes-your-follow-up-billing\" class=\"wp-block-heading\">The 90-day global period changes your follow-up billing<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">CMS assigns 19020 a 090 global period, which makes it a major surgical procedure. That window covers the day before surgery and the 90 days after it.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Routine post-operative care inside the window is already paid for. Anything beyond routine care needs a modifier that says so, and each one answers a different question.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>The window:<\/strong> One day before surgery, plus 90 days after the date of surgery<\/li>\n\n\n\n<li><strong>Bundled:<\/strong> Post-operative visits, wound checks, and packing changes tied to the abscess<\/li>\n\n\n\n<li><strong>Modifier 57:<\/strong> The evaluation visit where the decision for surgery was made<\/li>\n\n\n\n<li><strong>Modifier 24:<\/strong> An unrelated evaluation visit during the 90 days<\/li>\n\n\n\n<li><strong>Modifier 78:<\/strong> A return to the operating room for a related complication<\/li>\n\n\n\n<li><strong>Modifier 79:<\/strong> An unrelated procedure during the global period<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Teams that treat 19020 as a minor procedure bill visits Medicare already considers settled. Those charges get denied now, or clawed back later in an audit.<\/p>\n\n\n\n<h2 id=\"h-how-a-19020-claim-moves-from-the-operating-room-to-payment\" class=\"wp-block-heading\">How a 19020 claim moves from the operating room to payment<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">A 19020 charge passes through four sets of hands on its way through the <a href=\"https:\/\/pabau.com\/blog\/what-is-healthcare-revenue-cycle-management\/\">revenue cycle<\/a>. Each one of them can stall it.<\/p>\n\n\n\n<ol class=\"wp-block-list\">\n<li><strong>The surgeon dictates.<\/strong> Depth, side, drainage, and any packing or drain go into the note that day.<\/li>\n\n\n\n<li><strong>Coding assigns.<\/strong> 19020 goes out with LT or RT, linked to an abscess diagnosis rather than a mastitis code.<\/li>\n\n\n\n<li><strong>Charge entry checks the setting.<\/strong> The place-of-service code has to match the room where the surgery happened.<\/li>\n\n\n\n<li><strong>Billing starts the clock.<\/strong> The 90-day window opens on the day of surgery, and every later visit gets tested against it.<\/li>\n<\/ol>\n\n\n\n<p class=\"wp-block-paragraph\">Most delays trace back to step one. A coder cannot claim depth the surgeon never wrote, and a query to the surgeon adds days to the claim. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Keeping the note, the diagnosis, and the charge in one system removes that round trip. It also keeps records accessible for the audit trail your <a href=\"https:\/\/pabau.com\/blog\/hipaa-compliance-for-medical-offices\/\">HIPAA compliance<\/a> program has to show.<\/p>\n\n\n\n<h2 id=\"h-where-19020-claims-go-wrong\" class=\"wp-block-heading\">Where 19020 claims go wrong<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Most 19020 denials come from ordinary <a href=\"https:\/\/pabau.com\/blog\/what-is-medical-billing\/\">medical billing<\/a> errors rather than coverage disputes. Five of them show up again and again in audits of breast surgical codes.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Depth never documented:<\/strong> A note describing skin-level drainage supports a superficial code, not 19020. The record has to place the abscess in breast parenchyma.<\/li>\n\n\n\n<li><strong>Diagnosis stops at mastitis:<\/strong> N61.0 does not establish necessity for a surgical drainage. The diagnosis has to document the abscess.<\/li>\n\n\n\n<li><strong>Laterality left off:<\/strong> Most contractors and commercial payers want LT or RT on breast procedures, and the claim pends without one.<\/li>\n\n\n\n<li><strong>Modifier 22 by habit:<\/strong> Payers ask for the note whenever they see it. They recoup the extra payment when the note reads like a routine drainage.<\/li>\n\n\n\n<li><strong>Bundling with a superficial code:<\/strong> Reporting 19020 and 10060 for the same breast on the same date needs a valid 59 and two distinct sites.<\/li>\n<\/ul>\n\n\n\n<h3 id=\"h-before-you-submit-a-five-point-check\" class=\"wp-block-heading\">Before you submit: A five-point check<\/h3>\n\n\n\n<ol class=\"wp-block-list\">\n<li>The operative note says deep and names breast parenchyma.<\/li>\n\n\n\n<li>The diagnosis documents an abscess, not mastitis alone.<\/li>\n\n\n\n<li>LT or RT sits on the claim line.<\/li>\n\n\n\n<li>The place-of-service code matches where the surgery happened.<\/li>\n\n\n\n<li>The global period end date is written into the chart.<\/li>\n<\/ol>\n\n\n        <div id=\"pro_tip\">\n            <div class=\"img\">\n                <svg width=\"42\" height=\"42\" viewBox=\"0 0 42 42\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M12.6383 19.5238C12.6632 21.2071 12.8734 22.9926 12.0685 24.5523C11.0341 26.8917 8.45076 28.169 7.56292 30.5918C6.63082 33.1061 7.19505 36.185 9.31371 37.9786C10.929 39.5678 13.4183 39.9873 15.6061 39.5463C17.4592 39.073 19.1049 37.8388 19.9706 36.1608C20.781 34.7141 20.7866 32.9904 20.5293 31.3985C20.1006 29.3092 18.3775 27.8705 16.9807 26.362C14.8814 24.1005 14.6684 20.6854 15.595 17.8915C16.4331 15.4768 19.0026 14.2344 20.0425 11.9461C20.7202 10.6769 20.7506 9.20327 20.6068 7.81304C20.1864 5.40098 18.3139 3.23631 15.8716 2.56674C13.9742 2.03969 11.8224 2.30052 10.1739 3.37614C8.70522 4.34688 7.5878 5.86618 7.28356 7.58178C6.76081 9.82981 7.53525 12.2822 9.20307 13.9118C10.7658 15.4741 12.4806 17.2273 12.6383 19.5238Z\"\n                        fill=\"#2BADD4\" \/>\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M22.7048 19.8387C22.6822 22.3279 24.4507 24.6234 26.7493 25.4682C28.0531 25.961 29.4725 25.9183 30.7989 25.5487C32.0575 24.9955 33.301 24.2237 34.0069 23.0092C34.8384 21.5811 35.2982 19.8286 34.7832 18.2094C34.3611 16.2507 32.8739 14.6541 31.0275 13.9426C28.6736 12.9595 25.8073 13.7942 24.1719 15.7001C23.2022 16.8366 22.6143 18.3326 22.7048 19.8387Z\"\n                        fill=\"#2BADD4\" \/>\n                <\/svg>\n            <\/div>\n            <div class=\"text\">\n                <h3>Pro Tip<\/h3>\n                <p>Write the global period end date into the chart on the day of surgery. Your front desk then knows which follow-up visits are already covered, and which ones need modifier 24 or 78 before they go out the door.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-related-codes-worth-knowing\" class=\"wp-block-heading\">Related codes worth knowing<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Coders new to breast surgery confuse 19020 with the integumentary drainage codes more than any other pair. The line between them is anatomy and approach rather than abscess size.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">CPT code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Descriptor<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Key distinction from 19020<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">10060<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Incision and drainage of abscess, simple or single<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Integumentary code for skin and subcutaneous abscesses, not deep breast tissue<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">10061<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Incision and drainage of abscess, complicated or multiple<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Still an integumentary code, however complex the skin abscess turns out to be<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">10160<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Puncture aspiration of abscess, hematoma, bulla, or cyst<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Needle aspiration instead of an open incision, for collections that drain that way<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">19000<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Puncture aspiration of cyst of breast<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Breast-specific, but for cyst aspiration rather than abscess drainage or exploration<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">19020<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Mastotomy with exploration or drainage of abscess, deep<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The code once an open incision through breast parenchyma is required<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">So the test stays simple. Drainage that stays in skin and subcutaneous tissue is <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-10060\/\">10060<\/a> work, and aspirating a breast cyst is <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-19000\/\">19000<\/a>. Once the surgeon cuts through breast parenchyma to reach a deep abscess, 19020 is the code, whatever volume comes out.<\/p>\n\n\n\n<h2 id=\"h-how-pabau-keeps-19020-notes-and-claims-in-one-place\" class=\"wp-block-heading\">How Pabau keeps 19020 notes and claims in one place<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">A 19020 claim stalls when the paperwork and the charge live in different systems. Practice management software like Pabau keeps the operative note, the consent forms, and the invoice on one patient record. Your billing team reads the note and raises the charge in the same place.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Coding stays a human decision, and it should. What changes is the search. Nobody hunts through a shared drive for the note that proves depth, because it sits on the appointment it belongs to.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/pabau.com\/features\/patient-intake-software\/\">Digital intake forms<\/a> collect history and consent before the patient arrives, so the pre-operative record is complete on the day of surgery.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/cpt-code-19020\/customizable-consent-and-intake-forms.webp\" alt=\"Customizable consent and intake forms\"\/><figcaption class=\"wp-element-caption\"><em>Consent and intake forms attach to the patient record before surgery, so the pre-operative file is complete when coding starts.<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:35px;width:800px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<p class=\"wp-block-paragraph\">Pabau&#8217;s <a href=\"https:\/\/pabau.com\/features\/claims-management-software\/\">claims management software<\/a> then tracks each insurance claim against that record. Reporting shows which claims are still open, so an unpaid surgical charge does not quietly age out.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/cpt-code-19020\/track-claims-from-start-to-finish.webp\" alt=\"Track claims from start to finish\"\/><figcaption class=\"wp-element-caption\"><em>Claim tracking shows where every insurance claim sits, so an unpaid 19020 charge does not sit unnoticed for weeks.<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:35px;width:800px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<p class=\"wp-block-paragraph\">Practices running several surgical codes at once use <a href=\"https:\/\/pabau.com\/blog\/practice-management-software\/\">practice management software<\/a> to keep documentation and billing on the same timeline. Nobody has to reconcile two systems at month end.<\/p>\n\n\n        <div id=\"book_a_demo\">\n            <div class=\"left-side\">\n                <div class=\"logo\">\n                    <img decoding=\"async\"\n                        src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Logo.svg\"\n                        alt=\"Logo\"\n                        loading=\"lazy\"\n                    \/>\n                <\/div>\n\n                <h3 class=\"heading\">\n                    Keep surgical notes and claims on one record                <\/h3>\n\n                <p class=\"description\">\n                    Pabau keeps operative notes, consent forms, and invoices on the same patient record. Your billing team can support a 19020 claim without chasing paperwork across systems.                <\/p>\n\n                <div class=\"button-group\">\n                    <a href=\"\/book-demo\/\" class=\"btn btn-scale-effect btn-cta-color btn-md\">\n                        <span class=\"btn-text\">Book a demo<\/span>\n                        <div class=\"btn-icon btn-icon-right\" aria-hidden=\"true\">\n                            <svg\n                                width=\"14\"\n                                height=\"12\"\n                                viewBox=\"0 0 14 12\"\n                                fill=\"none\"\n                                xmlns=\"http:\/\/www.w3.org\/2000\/svg\"\n                            >\n                                <path\n                                    d=\"M0.75 4.77295C0.335786 4.77295 0 5.10874 0 5.52295C0 5.93716 0.335786 6.27295 0.75 6.27295V5.52295V4.77295ZM13.2803 6.05328C13.5732 5.76039 13.5732 5.28551 13.2803 4.99262L8.50736 0.219648C8.21447 -0.073245 7.73959 -0.073245 7.4467 0.219648C7.15381 0.512542 7.15381 0.987415 7.4467 1.28031L11.6893 5.52295L7.4467 9.76559C7.15381 10.0585 7.15381 10.5334 7.4467 10.8263C7.73959 11.1191 8.21447 11.1191 8.50736 10.8263L13.2803 6.05328ZM0.75 5.52295V6.27295L12.75 6.27295V5.52295V4.77295L0.75 4.77295V5.52295Z\"\n                                    fill=\"currentColor\"\n                                ><\/path>\n                            <\/svg>\n                        <\/div>\n                    <\/a>\n                <\/div>\n            <\/div>\n\n            <div class=\"right-side\">\n                <img decoding=\"async\"\n                    src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Home-Page-Concept-4.webp\"\n                    alt=\"Pabau clinic management dashboard\"\n                    loading=\"lazy\"\n                \/>\n            <\/div>\n        <\/div>\n        \n\n\n<h2 id=\"h-conclusion\" class=\"wp-block-heading\">Conclusion<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Three details decide whether 19020 pays on the first pass. The note has to say deep, the claim has to say which breast, and the place of service has to match the room. Everything else follows from those three.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The 90-day global period is the part worth writing down. Mark the end date in the chart on the day of surgery, and your team stops billing visits Medicare has already paid for.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">In most practices the coding is sound and the paperwork is what slips. <a href=\"https:\/\/pabau.com\/book-demo\/\">Book a demo<\/a> to see how Pabau keeps operative notes, diagnoses, and claims on one patient record.<\/p>\n\n\n        <div id=\"expert_picks\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/11\/Expert-Picks.svg\" alt=\"Continue your research\" height=\"42\" width=\"42\">\n                                <h3>Continue your research<\/h3>\n            <\/div>\n            <div class=\"content\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Aspirating a breast cyst instead of draining an abscess?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-19000\/\">CPT 19000<\/a> walks through the descriptor, diagnosis pairings, and Medicare rates.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Coding an excision rather than a drainage?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-19125\/\">CPT 19125<\/a> covers the documentation and reimbursement for open breast lesion excision.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Billing reconstructive surgery in the same practice?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-21195\/\">CPT 21195<\/a> sets out the modifiers and global period rules for mandibular reconstruction.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Adding graft procedures to your fee schedule?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-21235\/\">CPT 21235<\/a> explains how cartilage graft work is documented and billed.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Need the diagnosis side of breast coding?<\/strong> <a href=\"https:\/\/pabau.com\/diagnostic-codes\/icd-10-code-c50411\/\">ICD-10 C50.411<\/a> shows how laterality and specificity work in breast diagnosis codes.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-frequently-asked-questions\" class=\"wp-block-heading\">Frequently asked questions<\/h2>\n\n\n\n<div class=\"schema-faq wp-block-yoast-faq-block\"><div class=\"schema-faq-section\" id=\"faq-question-1786603504205\"><h3 class=\"schema-faq-question\">Is CPT 19020 a major or minor surgical procedure?<\/h3> <p class=\"schema-faq-answer\">It is a major procedure. CMS assigns 19020 a 90-day global period, so routine post-operative care is bundled for three months after surgery.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786603504206\"><h3 class=\"schema-faq-question\">Can CPT 19020 be performed in a physician&#8217;s office?<\/h3> <p class=\"schema-faq-answer\">Yes. Medicare prices 19020 in both office and facility settings, and the office rate is the higher of the two. Abscess depth and anesthesia needs usually decide the setting.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786603504207\"><h3 class=\"schema-faq-question\">Does CPT 19020 need prior authorization?<\/h3> <p class=\"schema-faq-answer\">Traditional Medicare does not require prior authorization for 19020. Many commercial and Medicare Advantage plans do, so check the plan&#8217;s surgical list before scheduling.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786603504208\"><h3 class=\"schema-faq-question\">How do I bill a second drainage inside the global period?<\/h3> <p class=\"schema-faq-answer\">Append modifier 78 when the patient returns to the operating room for a related complication. Use modifier 58 instead when the second drainage was staged or planned from the start.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786603504209\"><h3 class=\"schema-faq-question\">What is the difference between CPT 19020 and 19101?<\/h3> <p class=\"schema-faq-answer\">19101 is an open incisional biopsy of the breast, performed to get tissue for diagnosis. 19020 explores or drains an abscess, and the goal is infection control.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786603504210\"><h3 class=\"schema-faq-question\">Is drain placement included in CPT 19020?<\/h3> <p class=\"schema-faq-answer\">Yes. Placing a drain during the mastotomy is part of the procedure, and removing it during the global period is bundled as well.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786603504211\"><h3 class=\"schema-faq-question\">Can a nurse practitioner bill CPT 19020?<\/h3> <p class=\"schema-faq-answer\">Yes, where state scope of practice and payer credentialing allow it. The claim carries the performing provider&#8217;s own NPI unless incident-to rules apply.<\/p> <\/div> <\/div>\n","protected":false},"excerpt":{"rendered":"<p>CPT code 19020 covers mastotomy with exploration or drainage of a deep breast abscess. The surgeon opens the breast, works through the tissue, and drains a collection that antibiotics could not clear. Two words in the descriptor decide whether the claim pays. The first is deep, the second is exploration. When the operative note skips [&hellip;]<\/p>\n","protected":false},"author":85,"featured_media":177223,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_yoast_wpseo_linkdex":"85","_yoast_wpseo_content_score":"90","_yoast_wpseo_is_cornerstone":"","_yoast_wpseo_keywordsynonyms":"[\"\",\"\",\"\",\"\"]","_yoast_wpseo_focuskw_text_input":"","_seo_original_html":"","footnotes":""},"categories":[1433,1546],"tags":[],"class_list":["post-177224","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-billing-codes","category-cpt-codes"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v28.3 (Yoast SEO v28.3) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>CPT code 19020: Deep breast abscess drainage billing<\/title>\n<meta name=\"description\" content=\"CPT code 19020 covers open drainage of a deep breast abscess. 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See the 90-day global period, ICD-10 pairings, modifiers, and 2026 rates.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/pabau.com\/de\/procedure-codes\/cpt-code-19020\/\" \/>\n<meta property=\"og:site_name\" content=\"Pabau\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/Pabau\/\" \/>\n<meta property=\"article:published_time\" content=\"2026-08-13T10:16:40+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2026-08-13T13:14:25+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/08\/cpt-code-19020.webp\" \/>\n\t<meta property=\"og:image:width\" content=\"1200\" \/>\n\t<meta property=\"og:image:height\" content=\"630\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/webp\" \/>\n<meta name=\"author\" content=\"Monika Lazarevska\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@pabaucrm\" \/>\n<meta name=\"twitter:site\" content=\"@pabaucrm\" \/>\n<meta name=\"twitter:label1\" content=\"Verfasst von\" \/>\n\t<meta name=\"twitter:data1\" content=\"Monika Lazarevska\" \/>\n\t<meta name=\"twitter:label2\" content=\"Gesch\u00e4tzte Lesezeit\" \/>\n\t<meta name=\"twitter:data2\" content=\"12\u00a0Minuten\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/pabau.com\\\/de\\\/procedure-codes\\\/cpt-code-19020\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/de\\\/procedure-codes\\\/cpt-code-19020\\\/\"},\"author\":{\"name\":\"Monika Lazarevska\",\"@id\":\"https:\\\/\\\/pabau.com\\\/de\\\/#\\\/schema\\\/person\\\/5763062f66fccbf75a390f99ee0b985a\"},\"headline\":\"CPT code 19020: Mastotomy with exploration or drainage of abscess\",\"datePublished\":\"2026-08-13T10:16:40+00:00\",\"dateModified\":\"2026-08-13T13:14:25+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/de\\\/procedure-codes\\\/cpt-code-19020\\\/\"},\"wordCount\":2474,\"publisher\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/de\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/de\\\/procedure-codes\\\/cpt-code-19020\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/08\\\/cpt-code-19020.webp\",\"articleSection\":[\"Billing Codes\",\"CPT Codes\"],\"inLanguage\":\"de\"},{\"@type\":[\"WebPage\",\"FAQPage\"],\"@id\":\"https:\\\/\\\/pabau.com\\\/de\\\/procedure-codes\\\/cpt-code-19020\\\/\",\"url\":\"https:\\\/\\\/pabau.com\\\/de\\\/procedure-codes\\\/cpt-code-19020\\\/\",\"name\":\"CPT code 19020: Deep breast abscess drainage billing\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/de\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/de\\\/procedure-codes\\\/cpt-code-19020\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/de\\\/procedure-codes\\\/cpt-code-19020\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/08\\\/cpt-code-19020.webp\",\"datePublished\":\"2026-08-13T10:16:40+00:00\",\"dateModified\":\"2026-08-13T13:14:25+00:00\",\"description\":\"CPT code 19020 covers open drainage of a deep breast abscess. 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Use modifier 58 instead when the second drainage was staged or planned from the start.","inLanguage":"de"},"inLanguage":"de"},{"@type":"Question","@id":"https:\/\/pabau.com\/de\/procedure-codes\/cpt-code-19020\/#faq-question-1786603504209","position":5,"url":"https:\/\/pabau.com\/de\/procedure-codes\/cpt-code-19020\/#faq-question-1786603504209","name":"What is the difference between CPT 19020 and 19101?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"19101 is an open incisional biopsy of the breast, performed to get tissue for diagnosis. 19020 explores or drains an abscess, and the goal is infection control.","inLanguage":"de"},"inLanguage":"de"},{"@type":"Question","@id":"https:\/\/pabau.com\/de\/procedure-codes\/cpt-code-19020\/#faq-question-1786603504210","position":6,"url":"https:\/\/pabau.com\/de\/procedure-codes\/cpt-code-19020\/#faq-question-1786603504210","name":"Is drain placement included in CPT 19020?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"Yes. Placing a drain during the mastotomy is part of the procedure, and removing it during the global period is bundled as well.","inLanguage":"de"},"inLanguage":"de"},{"@type":"Question","@id":"https:\/\/pabau.com\/de\/procedure-codes\/cpt-code-19020\/#faq-question-1786603504211","position":7,"url":"https:\/\/pabau.com\/de\/procedure-codes\/cpt-code-19020\/#faq-question-1786603504211","name":"Can a nurse practitioner bill CPT 19020?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"Yes, where state scope of practice and payer credentialing allow it. The claim carries the performing provider's own NPI unless incident-to rules apply.","inLanguage":"de"},"inLanguage":"de"}]}},"yoast":{"focus_keyword":"cpt code 19020","seo_title":"CPT code 19020: Deep breast abscess drainage billing","meta_description":"CPT code 19020 covers open drainage of a deep breast abscess. See the 90-day global period, ICD-10 pairings, modifiers, and 2026 rates.","content_score":"90","is_cornerstone":"","related_keyphrases":[{"keyword":"incision and drainage of abscess cpt code","score":56},{"keyword":"breast abscess drainage cpt","score":83},{"keyword":"cpt code global period","score":61}]},"_links":{"self":[{"href":"https:\/\/pabau.com\/de\/wp-json\/wp\/v2\/posts\/177224","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pabau.com\/de\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/pabau.com\/de\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/pabau.com\/de\/wp-json\/wp\/v2\/users\/85"}],"replies":[{"embeddable":true,"href":"https:\/\/pabau.com\/de\/wp-json\/wp\/v2\/comments?post=177224"}],"version-history":[{"count":3,"href":"https:\/\/pabau.com\/de\/wp-json\/wp\/v2\/posts\/177224\/revisions"}],"predecessor-version":[{"id":179926,"href":"https:\/\/pabau.com\/de\/wp-json\/wp\/v2\/posts\/177224\/revisions\/179926"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/pabau.com\/de\/wp-json\/wp\/v2\/media\/177223"}],"wp:attachment":[{"href":"https:\/\/pabau.com\/de\/wp-json\/wp\/v2\/media?parent=177224"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/pabau.com\/de\/wp-json\/wp\/v2\/categories?post=177224"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/pabau.com\/de\/wp-json\/wp\/v2\/tags?post=177224"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}