{"id":178571,"date":"2026-08-14T09:13:16","date_gmt":"2026-08-14T09:13:16","guid":{"rendered":"https:\/\/pabau.com\/?p=178571"},"modified":"2026-08-14T10:32:45","modified_gmt":"2026-08-14T10:32:45","slug":"cpt-code-19086","status":"publish","type":"post","link":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-19086\/","title":{"rendered":"CPT code 19086: MRI-guided breast biopsy add-on billing guide"},"content":{"rendered":"\n<script type=\"application\/ld+json\">{\"@context\":\"https:\/\/schema.org\",\"@type\":\"MedicalWebPage\",\"headline\":\"CPT code 19086: MRI-guided breast biopsy, each additional lesion\",\"description\":\"CPT code 19086 is the add-on code for percutaneous breast biopsy under magnetic resonance guidance, each additional lesion. Descriptor, modifiers, ICD-10 pairings, coverage and documentation rules explained.\",\"url\":\"https:\/\/pabau.com\/procedure-codes\/cpt-code-19086\/\",\"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\":\"2026-08-11\",\"dateModified\":\"2026-08-14\"}<\/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 19086 is the add-on code for percutaneous breast biopsy under magnetic resonance guidance, reported once for each additional lesion.<\/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>It is always billed with parent code 19085, and it is never valid on its own.<\/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>MR guidance is bundled into the pair, so CPT 77021 is not reported separately with 19085 or 19086.<\/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>Stereotactic guidance belongs to 19081 and 19082, and ultrasound guidance to 19083 and 19084.<\/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>CMS article A57848 covers tomosynthesis-guided biopsy, so it is the wrong citation for an MRI-guided claim.<\/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 pre-fills the claim from the record and checks the insurer details before you send it.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<p class=\"wp-block-paragraph\">Two enhancing lesions show up on a contrast-enhanced breast MRI. Both get sampled in the same session. Then the claim goes out with a single code on it, and the second lesion goes unpaid.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">CPT code 19086 is the line that captures that second lesion. It covers each additional lesion biopsied under magnetic resonance guidance, and it only travels with CPT 19085.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Two habits break it. One is leaving the parent code off the claim. Another is reaching for whichever biopsy pair you use most often. Both are easy to catch before the file leaves your practice.<\/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-cpt-code-19086-covers-every-lesion-after-the-first\" class=\"wp-block-heading\">CPT code 19086 covers every lesion after the first<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>CPT code 19086<\/strong> covers percutaneous breast biopsy performed under magnetic resonance guidance, for each additional lesion beyond the first. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The <a href=\"https:\/\/www.ama-assn.org\/practice-management\/cpt\/cpt-code-set-overview\" target=\"_blank\" rel=\"nofollow noopener\">American Medical Association (AMA)<\/a> maintains the CPT code set, and it prints this descriptor in two parts. One parent statement runs across the whole 19081 to 19086 family, then each code adds its own line.<\/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;min-width:140px\">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\">Code<\/td>\n<td style=\"padding:12px 16px;color:#374151\">19086<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Code type<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Add-on code (listed separately in addition to the primary procedure code)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Guidance modality<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Magnetic resonance (MRI)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Parent descriptor<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous;<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Text unique to 19086<\/td>\n<td style=\"padding:12px 16px;color:#374151\">each additional lesion, including magnetic resonance guidance (List separately in addition to code for primary procedure)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Short descriptor<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Bx breast add lesion mr imag<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Parent code<\/td>\n<td style=\"padding:12px 16px;color:#374151\">CPT 19085 (first lesion, including magnetic resonance guidance)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Global period<\/td>\n<td style=\"padding:12px 16px;color:#374151\">ZZZ, meaning the code is always part of another service and follows the global period of 19085<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Modifier 51 exempt?<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Yes, as with every add-on code<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Three things decide whether CPT code 19086 applies. The guidance has to be magnetic resonance, not ultrasound and not stereotactic. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Next, the lesion has to be the second or a later one sampled in that session. Placement of a localization device and specimen imaging are already included when they happen, so neither gets billed on its own.<\/p>\n\n\n\n<h2 id=\"h-19086-never-goes-on-a-claim-without-19085\" class=\"wp-block-heading\">19086 never goes on a claim without 19085<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The most common denial trigger is a claim that carries the add-on without its parent. These codes are a pair, so 19086 has to sit under 19085 on the same claim.<\/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;min-width:140px\">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\">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\">Used when<\/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\">Billed alone?<\/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\">19085<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Primary<\/td>\n<td style=\"padding:12px 16px;color:#374151\">First lesion biopsied under MRI guidance, with a localization device when one is placed<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Yes<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">19086<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Add-on<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Each additional lesion biopsied under MRI guidance in the same session<\/td>\n<td style=\"padding:12px 16px;color:#374151\">No, requires 19085<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Two lesions sampled under MRI guidance read as 19085 for the first and 19086 x1 for the second. Three lesions read as 19085 plus 19086 x2. So the add-on repeats once per lesion after the first, and it never covers the initial biopsy.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Guidance itself is bundled into both codes. Do not report CPT 77021, magnetic resonance guidance for needle placement, alongside 19085 or 19086. Specimen imaging is bundled the same way when it happens, which is what the phrase \u00abwhen performed\u00bb signals in the descriptor.<\/p>\n\n\n\n<h2 id=\"h-the-guidance-in-the-room-decides-which-pair-you-bill\" class=\"wp-block-heading\">The guidance in the room decides which pair you bill<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Codes 19081 through 19086 cover percutaneous image-guided breast biopsy across three modalities. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Each modality has a primary code for the first lesion and an add-on for every lesion after it. Stereotactic work starts with <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-19081\/\">CPT 19081<\/a>, ultrasound work with 19083, and MRI work with 19085.<\/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\">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\">Guidance modality<\/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\">Lesion position<\/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\">Code type<\/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\">19081<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Stereotactic<\/td>\n<td style=\"padding:12px 16px;color:#374151\">First lesion<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Primary<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">19082<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Stereotactic<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Each additional lesion<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Add-on (requires 19081)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">19083<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Ultrasound<\/td>\n<td style=\"padding:12px 16px;color:#374151\">First lesion<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Primary<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">19084<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Ultrasound<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Each additional lesion<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Add-on (requires 19083)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">19085<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Magnetic resonance (MRI)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">First lesion<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Primary<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">19086<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Magnetic resonance (MRI)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Each additional lesion<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Add-on (requires 19085)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Mixed-modality sessions trip up otherwise clean claims. Say the first lesion is sampled under ultrasound and the second under MRI. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The claim then reads <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-19083\/\">CPT 19083<\/a> plus 19085, never 19083 plus 19086. An ultrasound second lesion takes <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-19084\/\">CPT 19084<\/a> instead, because an add-on only ever follows the primary from its own pair.<\/p>\n\n\n\n<h2 id=\"h-one-unit-of-19086-for-every-extra-lesion-sampled\" class=\"wp-block-heading\">One unit of 19086 for every extra lesion sampled<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Report CPT code 19086 once for every lesion biopsied after the first in the same session. CPT sets no fixed cap on units, so three additional lesions means three units. Each one needs its own documentation.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A contralateral lesion counts as an additional lesion rather than a second primary. Say the first lesion sits in the right breast and the second in the left, both under MRI guidance. The claim reads 19085 for the first lesion and 19086 for the contralateral one. Laterality modifiers then tell the payer which side each line describes.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Other breast add-ons count the same way. <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-19001\/\">CPT 19001<\/a> repeats for each extra cyst aspirated in one visit. Whatever the code, the habit is the same. Count the lesions in the note, then count the lines on the claim.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Unit limits still bite in practice. CMS publishes medically unlikely edit (MUE) values quarterly, and a line above the current value suspends for record review. Check the MUE table for 19086 before you submit a high-unit claim. Commercial payers apply their own thresholds too.<\/p>\n\n\n\n<h2 id=\"h-what-medicare-pays-depends-on-setting-and-locality\" class=\"wp-block-heading\">What Medicare pays depends on setting and locality<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Medicare pays CPT code 19086 through the Medicare Physician Fee Schedule (MPFS), which the <a href=\"https:\/\/www.cms.gov\/medicare\/physician-fee-schedule\/search\/overview\" target=\"_blank\" rel=\"nofollow noopener\">Centers for Medicare and Medicaid Services (CMS)<\/a> administers. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Two things move the rate. The first is the setting where the work happens, and the second is your geographic locality.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Pricing a line for your own market takes four steps:<\/p>\n\n\n\n<ol class=\"wp-block-list\">\n<li>Pull the work, practice expense and malpractice RVU values for 19086 from the fee schedule lookup.<\/li>\n\n\n\n<li>Multiply each RVU by the matching geographic practice cost index (GPCI) value for your locality.<\/li>\n\n\n\n<li>Add the three adjusted figures together, then multiply the total by that year&#8217;s conversion factor.<\/li>\n\n\n\n<li>Use the facility figure for hospital outpatient and ASC work, and the non-facility figure for office work.<\/li>\n<\/ol>\n\n\n\n<p class=\"wp-block-paragraph\">The facility rate sits lower because the hospital bills the overhead on its own claim. As an add-on, 19086 carries RVUs for the incremental work of the extra lesion, not for a full procedure. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Teams billing breast procedures inside a <a href=\"https:\/\/pabau.com\/industry\/plastic-surgery-emr\/\">plastic surgery practice<\/a> should confirm locality rates each January, when the schedule updates.<\/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>Check your Medicare Administrative Contractor (MAC) fee schedule as well as the national average. MACs apply locality GPCI values that move reimbursement in both directions. Coastal urban markets often sit above the national figure, while rural localities in the Midwest and South often sit below it. Pull the number for your own locality before you build a revenue forecast on 19086.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-lt-and-rt-belong-on-the-line-51-never-does\" class=\"wp-block-heading\">LT and RT belong on the line, 51 never does<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Three modifiers matter on a 19086 line, and one of them is a trap. LT and RT report the side. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Modifier 59 has a narrow, defensive use. As for 51, it never applies, because add-on codes are exempt from the multiple-procedure reduction.<\/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;min-width:140px\">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\">Name<\/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\">The additional lesion sits in the left breast<\/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\">The additional lesion sits in the right breast<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\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 payer edit bundles the add-on with the primary and the record supports a separate, distinct service<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\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\">Never. Add-on codes are modifier 51 exempt under AMA policy<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Payers expect laterality on breast procedure codes, because they have to know which side was treated. Apply LT or RT to 19086 the same way you apply it to 19085. Lesions in the same breast carry the same modifier on both lines, while a contralateral lesion carries the opposite one.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Modifier 59 is a defensive tool, not a routine one. Some commercial payers do not follow AMA add-on logic, and their edits flag 19086 anyway. Use 59 only where the record clearly supports a distinct service, and check the payer policy first.<\/p>\n\n\n\n<h2 id=\"h-the-diagnosis-has-to-justify-that-specific-lesion\" class=\"wp-block-heading\">The diagnosis has to justify that specific lesion<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Every 19086 line needs a diagnosis code that carries medical necessity for the lesion on that line. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">MRI-guided biopsy usually follows an enhancing finding that only the MRI can see, so these pairings differ from the ones used on mammographic work.<\/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;min-width:140px\">ICD-10-CM 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\">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\">R92.8<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Other abnormal and inconclusive findings on diagnostic imaging of breast<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Fits an enhancing lesion seen on MRI alone, the usual indication for 19085 and 19086<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">N63.11<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Unspecified lump in the right breast, upper outer quadrant<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Use when the record documents both laterality and quadrant<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">N63.21<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Unspecified lump in the left breast, upper outer quadrant<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Same logic on the left side<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Z80.3<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Family history of malignant neoplasm of breast<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Supports the high-risk screening MRI that found the lesion<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Z15.01<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Genetic susceptibility to malignant neoplasm of breast<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Common on referrals for BRCA carriers<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Z85.3<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Personal history of malignant neoplasm of breast<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Supports surveillance MRI after breast cancer treatment<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">The last three codes come from surveillance rather than symptoms. High-risk screening often starts in an <a href=\"https:\/\/pabau.com\/industry\/obgyn-emr-software\/\">OB-GYN practice<\/a>, where the family history and genetic results already sit on file. Once pathology confirms cancer, later encounters move to a code such as <a href=\"https:\/\/pabau.com\/diagnostic-codes\/icd-10-code-c50411\/\">C50.411<\/a>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Code to the highest level of specificity the record supports at the time of the procedure. Where the MRI report gives laterality and quadrant, use a code that carries both. Unspecified codes are accepted when the location is genuinely not established, though they attract more scrutiny on audit.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Match the diagnosis on the add-on line to the lesion that line describes. Copying the first lesion&#8217;s diagnosis onto every unit of 19086 makes a multi-lesion claim harder to defend.<\/p>\n\n\n\n<h2 id=\"h-coverage-for-mri-guided-biopsy-sits-with-your-mac\" class=\"wp-block-heading\">Coverage for MRI-guided biopsy sits with your MAC<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">No national Medicare policy names MRI guidance for percutaneous breast biopsy. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.cms.gov\/medicare-coverage-database\/view\/ncd.aspx?ncdid=272&amp;ncdver=1\" target=\"_blank\" rel=\"nofollow noopener\">NCD 220.13, Percutaneous Image-Guided Breast Biopsy<\/a>, has covered this work since January 2003, and it names stereotactic or ultrasound imaging only. Coverage for the MRI-guided pair therefore sits with each Medicare Administrative Contractor.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">One citation is worth correcting, because it circulates widely on breast biopsy pages. CMS article <a href=\"https:\/\/www.cms.gov\/medicare-coverage-database\/view\/article.aspx?articleid=57848\" target=\"_blank\" rel=\"nofollow noopener\">A57848, Billing and Coding: Tomosynthesis-Guided Breast Biopsy<\/a>, addresses tomosynthesis-guided work. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">That falls to the stereotactic pair, 19081 and 19082, or to unlisted code 19499. Quoting it in an MRI appeal weakens the appeal.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Look up your own contractor&#8217;s policy in the CMS Medicare Coverage Database before the procedure date. Where a contractor publishes nothing specific to MRI-guided biopsy, necessity is judged on the clinical record alone. Payers generally expect that record to show:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>A contrast-enhanced breast MRI identifying a suspicious enhancing lesion that needs tissue sampling<\/li>\n\n\n\n<li>Evidence the lesion is not visible on targeted second-look ultrasound or mammography, which would move the biopsy to 19083 or 19081<\/li>\n\n\n\n<li>Tissue obtained from every lesion billed, with a pathology specimen for each<\/li>\n\n\n\n<li>A localization marker placed and confirmed on post-procedure imaging, where placement was performed<\/li>\n\n\n\n<li>A practitioner trained in MRI-guided breast biopsy performing or supervising the procedure<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Most of that evidence comes together before the patient reaches the biopsy suite. Suspicious findings often pass through a <a href=\"https:\/\/pabau.com\/templates\/multidisciplinary-review\/\">multidisciplinary review<\/a> first, and that discussion belongs in the record alongside the MRI report.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Coverage limits follow the same logic across contractors. A biopsy without an imaging finding to justify it will not meet necessity. Palpable lesions that can be sampled without image guidance are also hard to defend under these codes. Keeping those records <a href=\"https:\/\/pabau.com\/blog\/hipaa-compliance-for-medical-offices\/\">HIPAA-compliant<\/a> is a baseline requirement, not an optional extra.<\/p>\n\n\n\n<h2 id=\"h-sequence-the-claim-first-document-every-lesion-second\" class=\"wp-block-heading\">Sequence the claim first, document every lesion second<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Clean 19086 claims come down to two things. The claim needs the right line-item sequence, and the note needs to name every lesion. It helps to picture how the file moves.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The radiologist dictates the MRI report and the procedure note. A coder reads both, then builds the claim with 19085 on line one and 19086 on line two. Charge entry adds LT or RT to each line.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">From there the file hits the clearinghouse, which screens it before the payer ever sees it. An add-on with no primary above it stops at that point. These five steps prevent most first-pass denials.<\/p>\n\n\n\n<ol class=\"wp-block-list\">\n<li><strong>List 19085 first on the claim.<\/strong> CPT code 19086 belongs on the line after its parent. Clearinghouse edits reject an add-on that appears without its primary, or ahead of it.<\/li>\n\n\n\n<li><strong>Apply laterality modifiers to both lines.<\/strong> A left-breast session carries LT on 19085 and on 19086. Inconsistent laterality between primary and add-on is a common edit trigger.<\/li>\n\n\n\n<li><strong>Document each lesion separately.<\/strong> The MRI report and procedure note should name every biopsied lesion by quadrant or clock position and depth. Each note should also record the marker placed in that lesion.<\/li>\n\n\n\n<li><strong>Keep MR guidance and specimen imaging bundled.<\/strong> CPT 77021 is not reported with 19085 or 19086, and specimen imaging is not unbundled either, unless a payer policy specifically allows it.<\/li>\n\n\n\n<li><strong>Attach the MRI report.<\/strong> The contrast-enhanced study that identified the lesions establishes the indication. A missing report is the second most common cause of denial, behind sequencing errors.<\/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>Build a pre-submission check for multi-lesion MRI cases. Confirm 19085 is the primary, count the additional lesions, and confirm one unit of 19086 per additional lesion. Check that laterality modifiers match across every line, that CPT 77021 is not on the claim, and that the MRI report names each lesion separately. A one-minute review clears most 19086 denials before they happen.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-the-errors-that-stall-a-19086-claim-and-their-fixes\" class=\"wp-block-heading\">The errors that stall a 19086 claim, and their fixes<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The rule set behind CPT code 19086 is narrow, which makes its denial patterns predictable. Here are the errors that show up most often, with the fix for each.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Billing 19086 without 19085.<\/strong> An add-on cannot stand alone, so the line auto-denies when the primary is missing. Confirm 19085 is on the claim before submission.<\/li>\n\n\n\n<li><strong>Using the wrong pair for the guidance modality.<\/strong> Reporting 19086 for a lesion sampled under ultrasound or stereotactic guidance is a coding error and an upcoding risk. Match the modality to its pair before you code the session.<\/li>\n\n\n\n<li><strong>Citing CMS article A57848 in an MRI appeal.<\/strong> That article governs tomosynthesis-guided biopsy, which is stereotactic work. Quoting it on a 19086 denial hands the reviewer a reason to close the appeal.<\/li>\n\n\n\n<li><strong>Applying modifier 51.<\/strong> Add-on codes are modifier 51 exempt by definition. Appending it triggers a payment reduction that should never apply.<\/li>\n\n\n\n<li><strong>Unbundling guidance or specimen imaging.<\/strong> CPT 77021 and separate specimen imaging codes are already paid inside 19085 and 19086. Billing them again is a compliance risk.<\/li>\n\n\n\n<li><strong>Vague or missing ICD-10 diagnosis codes.<\/strong> A diagnosis that does not match the lesion on that line invites review. Pull the wording straight from the MRI report.<\/li>\n\n\n\n<li><strong>Inconsistent laterality modifiers.<\/strong> LT on 19085 and RT on 19086 tells the payer two sides were treated. Without documentation for both, the claim stalls.<\/li>\n<\/ul>\n\n\n\n<h2 id=\"h-how-pabau-keeps-multi-lesion-biopsy-claims-complete\" class=\"wp-block-heading\">How Pabau keeps multi-lesion biopsy claims complete<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Billing 19086 by hand depends on someone remembering that a second lesion was sampled. The coder then finds the parent code, matches the modifiers and checks each diagnosis, working from someone else&#8217;s note. Every one of those steps is a chance to lose the add-on.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Practice management software like Pabau keeps the record and the claim in one place. Pabau&#8217;s <a href=\"https:\/\/pabau.com\/features\/claims-management-software\/\">claims management software<\/a> pre-fills the claim from the record, so the codes attached to the service land on the charge lines. Coders also get CPT and ICD-10 lookup libraries on the same screen.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Before a claim can go out, Pabau checks that the required insurer fields are complete, including membership numbers and authorization codes. It then submits the claim electronically and tracks its status, so your team sees a denial without chasing the payer.<\/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-19086\/automate-claims-through-healthcode.webp\" alt=\"Pabau claims management screen showing insurer details on a claim\"\/><figcaption class=\"wp-element-caption\"><em>Pabau&#8217;s claims management screen checks the insurer details first, so a multi-lesion biopsy claim leaves the practice complete.<\/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\">Counting the lesions still belongs to your team. Pabau&#8217;s <a href=\"https:\/\/pabau.com\/features\/medical-records-management\/\">medical records management<\/a> holds the note and the charge lines on one client record. A session that sampled three lesions and billed only two is then easy to spot on review.<\/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                    Send breast biopsy claims that are complete                <\/h3>\n\n                <p class=\"description\">\n                    Pabau&#8217;s claims management software pre-fills each claim from the clinical record and checks the required insurer details before submission. Your team spends less time rebuilding claims that came back.                <\/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 claims 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\">Payment on a multi-lesion MRI biopsy is won or lost in the minute between the procedure note and the charge entry. Get the pair right, count the lesions, match the laterality, and 19086 pays without an appeal.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">So the practical move is to standardize that minute. Give the coder a note that names every lesion, then give the claim a sequence check before it leaves. One trade-off is worth remembering. MRI-guided biopsy has no national coverage policy, so your contractor decides the borderline cases.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Practices that keep the note and the claim in one system lose fewer add-on lines along the way. <a href=\"https:\/\/pabau.com\/book-demo\/\">Book a demo<\/a> to see how Pabau handles claim details for radiology and breast surgery teams.<\/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>Working the stereotactic side of the family?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-19081\/\">CPT code 19081<\/a> covers the primary code for stereotactic breast biopsy, with the same pairing rules.<\/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 the marker as well as the biopsy?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-19285\/\">CPT code 19285<\/a> explains when breast localization device placement is reported on its own.<\/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>Counting add-on units on another breast procedure?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-19001\/\">CPT code 19001<\/a> walks through the add-on for each additional cyst aspirated in one visit.<\/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>Documenting the meeting that sent the patient to biopsy?<\/strong> <a href=\"https:\/\/pabau.com\/templates\/multidisciplinary-review\/\">Multidisciplinary review template<\/a> gives you a structure for recording the decision and who made it.<\/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-1786700000001\"><h3 class=\"schema-faq-question\">Does CPT 19086 need prior authorization?<\/h3> <p class=\"schema-faq-answer\">It depends on the payer. Medicare has no national policy for MRI-guided breast biopsy, so authorization rules sit with your MAC. Many commercial plans do require it, so check before the procedure date.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786700000002\"><h3 class=\"schema-faq-question\">Can 19086 be used for a lesion biopsied on another day?<\/h3> <p class=\"schema-faq-answer\">No. The add-on only covers extra lesions sampled in the same session. A biopsy on another day is a new claim, with its own primary code.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786700000003\"><h3 class=\"schema-faq-question\">Who bills 19086 when the biopsy happens in a hospital?<\/h3> <p class=\"schema-faq-answer\">The physician bills 19086 on the professional claim, paid at the facility rate. The hospital reports its own charges on a separate facility claim.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786700000004\"><h3 class=\"schema-faq-question\">Does 19086 have its own global period?<\/h3> <p class=\"schema-faq-answer\">No. It carries a ZZZ global period, which means it follows the global period attached to 19085. Post-procedure care is handled under the primary code.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1786700000005\"><h3 class=\"schema-faq-question\">What if the pathology comes back benign?<\/h3> <p class=\"schema-faq-answer\">Nothing changes on the claim. Medical necessity rests on the imaging finding that led to the biopsy, not on the pathology result. Keep the MRI report with the record.<\/p> <\/div> <\/div>\n","protected":false},"excerpt":{"rendered":"<p>CPT code 19086 bills each extra lesion in an MRI-guided breast biopsy, always with 19085. Read more on modifiers, ICD-10 pairs and coverage.<\/p>\n","protected":false},"author":85,"featured_media":178565,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_yoast_wpseo_linkdex":"87","_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-178571","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 v28.2 (Yoast SEO v28.2) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>CPT code 19086: MRI-guided breast biopsy add-on billing guide<\/title>\n<meta name=\"description\" content=\"CPT code 19086 bills each extra lesion in an MRI-guided breast biopsy, always with 19085. Read more on modifiers, ICD-10 pairs and coverage.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-19086\/\" \/>\n<meta property=\"og:locale\" content=\"es_ES\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"CPT code 19086: MRI-guided breast biopsy add-on billing guide\" \/>\n<meta property=\"og:description\" content=\"CPT code 19086 bills each extra lesion in an MRI-guided breast biopsy, always with 19085. Read more on modifiers, ICD-10 pairs and coverage.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-19086\/\" \/>\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=\"2026-08-14T09:13:16+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2026-08-14T10:32:45+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/08\/cpt-code-19086.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=\"Escrito por\" \/>\n\t<meta name=\"twitter:data1\" content=\"Monika Lazarevska\" \/>\n\t<meta name=\"twitter:label2\" content=\"Tiempo de lectura\" \/>\n\t<meta name=\"twitter:data2\" content=\"13 minutos\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-19086\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-19086\\\/\"},\"author\":{\"name\":\"Monika Lazarevska\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/#\\\/schema\\\/person\\\/5763062f66fccbf75a390f99ee0b985a\"},\"headline\":\"CPT code 19086: MRI-guided breast biopsy add-on billing guide\",\"datePublished\":\"2026-08-14T09:13:16+00:00\",\"dateModified\":\"2026-08-14T10:32:45+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-19086\\\/\"},\"wordCount\":2692,\"publisher\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-19086\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/08\\\/cpt-code-19086.webp\",\"articleSection\":[\"Billing Codes\",\"CPT Codes\"],\"inLanguage\":\"es\"},{\"@type\":[\"WebPage\",\"FAQPage\"],\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-19086\\\/\",\"url\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-19086\\\/\",\"name\":\"CPT code 19086: MRI-guided breast biopsy add-on billing guide\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-19086\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-19086\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/08\\\/cpt-code-19086.webp\",\"datePublished\":\"2026-08-14T09:13:16+00:00\",\"dateModified\":\"2026-08-14T10:32:45+00:00\",\"description\":\"CPT code 19086 bills each extra lesion in an MRI-guided breast biopsy, always with 19085. 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It combines scheduling, electronic health records, clinical forms, payments, marketing automation, reporting, and patient engagement tools into one secure cloud system to help practices streamline operations and grow their business.\",\"foundingDate\":\"2011-10-20\",\"numberOfEmployees\":{\"@type\":\"QuantitativeValue\",\"minValue\":\"201\",\"maxValue\":\"500\"}},{\"@type\":\"Person\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/#\\\/schema\\\/person\\\/5763062f66fccbf75a390f99ee0b985a\",\"name\":\"Monika Lazarevska\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"es\",\"@id\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/07\\\/cropped-Monika-Lazarevska-skala-2-1-e1783430903842-1-96x96.jpg\",\"url\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/07\\\/cropped-Monika-Lazarevska-skala-2-1-e1783430903842-1-96x96.jpg\",\"contentUrl\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/07\\\/cropped-Monika-Lazarevska-skala-2-1-e1783430903842-1-96x96.jpg\",\"caption\":\"Monika Lazarevska\"},\"description\":\"Monika Lazarevska writes content for owners and healthcare professionals who want clear, no-fluff content that actually helps them run their practice better. With a background in storytelling and SEO, she knows how to make even the driest topics worth reading. Off the clock, you'll find her in a caf\u00e9 somewhere in Europe, probably with a good book and an even better coffee.\",\"url\":\"https:\\\/\\\/pabau.com\\\/es\\\/blog\\\/author\\\/monika-lazarevska\\\/\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-19086\\\/#faq-question-1786700000001\",\"position\":1,\"url\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-19086\\\/#faq-question-1786700000001\",\"name\":\"Does CPT 19086 need prior authorization?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"It depends on the payer. Medicare has no national policy for MRI-guided breast biopsy, so authorization rules sit with your MAC. Many commercial plans do require it, so check before the procedure date.\",\"inLanguage\":\"es\"},\"inLanguage\":\"es\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-19086\\\/#faq-question-1786700000002\",\"position\":2,\"url\":\"https:\\\/\\\/pabau.com\\\/es\\\/procedure-codes\\\/cpt-code-19086\\\/#faq-question-1786700000002\",\"name\":\"Can 19086 be used for a lesion biopsied on another day?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"No. The add-on only covers extra lesions sampled in the same session. 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A biopsy on another day is a new claim, with its own primary code.","inLanguage":"es"},"inLanguage":"es"},{"@type":"Question","@id":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-19086\/#faq-question-1786700000003","position":3,"url":"https:\/\/pabau.com\/es\/procedure-codes\/cpt-code-19086\/#faq-question-1786700000003","name":"Who bills 19086 when the biopsy happens in a hospital?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"The physician bills 19086 on the professional claim, paid at the facility rate. 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