CPT Code 10035: Soft tissue localization device placement guide

Key Takeaways

CPT Code 10035 covers percutaneous soft tissue localization device placement with imaging guidance for the first lesion.

Imaging guidance is bundled into 10035 and cannot be separately reported with CPT 76942 for the same lesion.

Modifier 26, TC, 59, LT, and RT are the most commonly applicable modifiers; wrong modifier selection is a leading denial cause.

Pabau’s claims management software links procedure documentation to CPT codes, reducing manual coding effort and denial rates.

CPT Code 10035 covers percutaneous placement of a soft tissue localization device, with imaging guidance, for the first lesion. Coders in radiology, breast surgery, and dermatology use it most often to mark a non-palpable lesion before a planned excision or biopsy.

Facility and non-facility rates differ substantially, and NCCI edits automatically flag the most common mistake: billing imaging guidance separately when it’s already bundled into 10035. This guide covers the official descriptor, modifiers, 2026 Medicare rates, ICD-10 crosswalks, related codes, documentation requirements, and the denial patterns that cost practices the most.

Radiology, breast surgery, and dermatology practices use image-guided marker placement as a routine pre-surgical step, and medical coders and billing specialists in those fields are the primary users of this reference. For other CPT coding references across specialties, the Pabau procedure code library covers the most commonly queried code families.

CPT Code 10035: Official description and clinical overview

The American Medical Association maintains CPT Code 10035 within the Introduction and Removal Procedures section of the Integumentary System. The official descriptor reads:

Three elements define whether CPT Code 10035 applies:

• The approach must be percutaneous (through the skin, not open surgical)
• Imaging guidance must be used during placement
• The claim must be for the first lesion only

The parenthetical device list (clip, metallic pellet, wire/needle, radioactive seeds) is illustrative, not exhaustive. Devices such as Magseed and SAVI SCOUT reflectors fall within the code’s scope, provided they’re placed percutaneously under imaging.

CPT Code 10035 vs CPT 10036: Understanding the add-on code

CPT 10036 is the add-on code for each additional lesion beyond the first. It is reported alongside 10035 and cannot be billed independently. A patient with three non-palpable lesions requiring pre-surgical localization would generate one unit of 10035 and two units of 10036.

The AMA CPT Assistant (June 2016) confirmed this structure for soft tissue localization 10035 and 10036 coding. Submitting 10036 without 10035 on the same claim will typically generate an automatic denial for a missing primary code.

When to use CPT Code 10035: Indications and clinical scenarios

CPT Code 10035 applies when a provider uses percutaneous image guidance to place a marker before a planned surgical excision or biopsy. The most common contexts are breast surgery and oncologic staging, though the code is not breast-specific.

• Non-palpable breast lesion localization: Wire/needle (Kopans wire) or radioactive seed localization (RSL) placed in advance of lumpectomy or wide local excision, typically the same day or morning of surgery
• Clip placement after biopsy: A metallic clip inserted to mark a biopsy site so the lesion can be re-located if the biopsy result changes the surgical plan
• Pre-surgical tumor bed marking: Fiducial markers placed percutaneously at a tumor margin before neoadjuvant chemotherapy, so the original lesion site can be excised even if the tumor responds completely to treatment
• Soft tissue mass marking in other sites: Subcutaneous or deeper soft tissue lesions in the extremities or trunk that require image-guided localization before open excision

Practices performing image-guided localization alongside dermatology or plastic surgery procedures benefit from using dermatology EMR software or plastic surgery EMR with integrated procedure coding to document these indications at the point of care.

Imaging guidance and bundling rules for CPT 10035

Imaging guidance is bundled into CPT Code 10035 by the AMA’s descriptor. The phrase “including imaging guidance” in the official language means the image guidance component is not separately reportable for the same lesion and the same encounter. In practice, this is the most common unbundling mistake coders make with this family of codes.

CPT 76942 (ultrasonic guidance for needle placement, with imaging supervision and interpretation) has an NCCI edit relationship with 10035. Submitting both on the same claim for the same lesion will trigger a bundling edit.

Verify current National Correct Coding Initiative (NCCI) edits via the CMS Physician Fee Schedule before making any payer-specific exception claims. NCCI edit tables are updated quarterly.

CPT Code 10035 modifiers

Modifier selection for CPT Code 10035 depends on who performed the procedure and where. Four modifiers account for the majority of correct-use scenarios.

Modifier guidance is payer-specific. Confirm modifier indicators for CPT Code 10035 in the CMS MPFS before assuming a modifier will always apply or always be accepted.

CPT Code 10035 reimbursement and Medicare fee schedule 2026

Medicare reimburses CPT Code 10035 at different rates depending on the site of service. The 2026 RVU lookup via FastRVU and the CMS Physician Fee Schedule confirm both a facility rate (where the hospital or outpatient surgery center absorbs equipment and staff costs) and a non-facility rate (where the physician’s office bears those costs, yielding a higher physician payment).

Facility vs non-facility rates for CPT 10035

Rates shown are approximate national averages. Geography matters: the Geographic Practice Cost Index (GPCI) adjusts payments upward in high-cost areas (New York, California) and downward in lower-cost MAC regions. Verify exact dollar amounts against the current CMS MPFS download for your MAC jurisdiction before quoting rates to physicians or administrators.

Private payer contracts typically reimburse at a percentage of Medicare fee schedule, so the facility/non-facility distinction carries over to commercial claims as well. Using practice management software with integrated fee schedule tracking makes it straightforward to flag when claims are submitted at the wrong site-of-service rate.

ICD-10 diagnosis codes paired with CPT Code 10035

Medical necessity for CPT Code 10035 is established through the accompanying diagnosis codes. Payers expect a diagnosis that explains why localization is clinically required before a surgical or biopsy procedure. Common ICD-10-CM codes paired with 10035 include:

Use the AAPC CPT-to-ICD-10 crosswalk to verify medical necessity alignment between 10035 and your diagnosis selection. The crosswalk flags diagnosis codes that carry a local coverage determination (LCD) requirement, which some MACs enforce for soft tissue localization procedures.

The same crosswalk logic applies whether the diagnosis is a benign finding, such as D34, or one of uncertain behavior, such as D43.2.

Related CPT codes to know alongside 10035

Understanding where CPT Code 10035 sits within the broader family of image-guided and tissue-related codes, such as CPT 71271, reduces unbundling risk and supports accurate claim construction. Practices managing a range of procedure code fee schedules benefit from keeping these relationships documented in their billing reference materials.

For coders who also handle other specialty-specific code families, reviewing ADHD screening CPT codes or IVF CPT codes alongside localization codes helps build facility with how add-on code structures and bundling rules apply across different CPT sections.

Documentation requirements for CPT Code 10035

Every CPT Code 10035 claim needs a procedure note that supports medical necessity and confirms all elements of the code descriptor. Missing or vague documentation is the second most common denial trigger after incorrect modifier use.

• Imaging modality used: State whether ultrasound, stereotactic, MRI, or mammographic guidance was used during placement
• Device type: Name the specific device placed (wire, clip, metallic pellet, radioactive seed, or brand-equivalent such as Magseed or SAVI SCOUT) and confirm percutaneous approach
• Lesion location and laterality: Document the anatomical site, side (left/right), and clock-face or quadrant location for breast procedures
• Number of lesions treated: Explicitly state whether one or multiple localization devices were placed; this supports correct 10035 + 10036 unit billing
• Provider performing the procedure: Identify the qualified practitioner; if professional and technical components are split across providers, document each provider’s role separately
• Pre-procedure indication: Note the clinical reason localization is necessary, supporting the ICD-10 diagnosis on the claim

Maintaining HIPAA-compliant documentation practices for image-guided procedures protects both the claim and the practice in the event of a MAC audit.

Using digital forms designed around procedure documentation checklists ensures the procedure note consistently captures every required element before the encounter is closed. Strong documentation habits also align with broader advice on managing medical forms.

Common billing errors and denial reasons for CPT Code 10035

Most CPT 10035 denials trace to five root causes, each with a specific fix once you know what to look for.

Reduce CPT claim denials with end-to-end billing workflows

Pabau connects procedure documentation directly to CPT billing, so your team submits claims with the right codes, correct modifiers, and supporting documentation — without switching between systems.

Book a demo

• Unbundling imaging guidance: Billing CPT 76942 alongside 10035 for the same lesion on the same date triggers an NCCI bundling edit. The NCCI edit will deny or reduce the 76942 automatically. Remove 76942 from claims where the same provider performed both the localization and the image guidance in the same session.
• Missing or incorrect modifier: Submitting 10035 without modifier 26 when performed in a facility setting overstates the physician’s entitlement (the facility is due the technical component). Conversely, applying modifier 26 in a non-facility (office) setting understates the payment. Confirm the place-of-service code and the CMS indicator for this code before selecting a modifier.
• Wrong site-of-service code: The place-of-service (POS) code on the claim must match the actual setting. POS 11 (office) triggers the non-facility rate. POS 22 (outpatient hospital) and POS 24 (ambulatory surgical center) both trigger the facility rate. A mismatch between POS code and the actual setting is flagged in post-payment audits and generates overpayment demand letters.
• 10036 billed without 10035: 10036 is an add-on code and cannot stand alone. If 10035 is missing from the claim (due to a data entry error or a dropped line item), the payer will deny 10036. Always verify the parent code is present before submitting.
• Inadequate documentation for medical necessity: If the procedure note does not document why percutaneous localization was required, some MACs will deny on medical necessity grounds even when the ICD-10 crosswalk is technically valid. The note must explain why the lesion was non-palpable or otherwise required image guidance for localization.

Practices using claims management software with pre-submission auditing catch the majority of these errors before the claim leaves the practice. A rules-based pre-authorization check that flags 76942 alongside 10035 on the same claim line eliminates the most common unbundling denial automatically.

Conclusion

CPT Code 10035 is a precise, well-defined code where most claim failures stem from avoidable process errors: bundled imaging codes that should not be on the claim, site-of-service mismatches, and missing modifier logic. Getting the documentation right at the point of care eliminates the majority of denial risk before the claim is submitted.

Pabau’s claims management software connects procedure documentation directly to CPT code selection and pre-submission audit rules, so billers see potential conflicts before claims leave the practice. To see how the workflow handles codes like 10035 end to end, book a demo.

Continue your research

Need a broader overview of practice billing workflows? Practice management software covers how integrated billing, scheduling, and documentation reduce administrative overhead in clinical practices.

Working in aesthetics or dermatology alongside surgical coding? Dermatology EMR software explains how EMR platforms built for skin and aesthetic specialties support procedure documentation and CPT billing.

Want to understand HIPAA obligations for procedure records? HIPAA compliance outlines the documentation retention and security requirements that apply to procedure notes supporting CPT claims.

Frequently Asked Questions