CPT code 19083: Ultrasound-guided breast biopsy billing guide

Key Takeaways

CPT code 19083 covers percutaneous breast biopsy with ultrasound imaging guidance, first lesion, including clip placement and specimen imaging when performed.

Use add-on code 19084 for each additional lesion biopsied under ultrasound guidance in the same session – never report 19084 alone.

Non-facility Medicare rates for CPT 19083 are higher than facility rates due to practice expense RVU differences; always confirm current-year rates via the CMS Physician Fee Schedule lookup.

Practice management software like Pabau helps radiology and surgical practices structure procedure documentation, modifier selection, and ICD-10 pairings for CPT 19083 so records stay audit-ready.

CPT code 19083 is the procedure code for a percutaneous breast biopsy performed with real-time ultrasound guidance, covering the first lesion biopsied in a session. Payers frequently deny claims for this code over three recurring errors: the wrong imaging guidance code, a missing laterality modifier, or an ICD-10 pairing that doesn’t satisfy the payer’s local coverage determination.

This reference covers the full billing picture for CPT code 19083: the official AMA code description, the add-on code relationship with 19084, applicable modifiers, covered ICD-10 diagnoses, 2026 Medicare fee schedule rates and RVUs, documentation requirements, and the most common claim errors that trigger denials for percutaneous breast biopsy procedures.

CPT code 19083: Definition and clinical description

CPT code 19083 carries significant specificity requirements, and structured documentation practices for radiology and surgical teams need to capture every element of it accurately. The official AMA descriptor reads: Biopsy, breast, with placement of breast localization device(s) (e.g., clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including ultrasound guidance.

Three elements in that descriptor matter for billing. First, the procedure is percutaneous – the physician advances a core or vacuum-assisted needle device through the skin to the target lesion. Second, the code covers the first lesion biopsied. Third, ultrasound guidance is the imaging modality. If the guidance modality is different (stereotactic, MRI, tomosynthesis), a different code applies entirely.

The parenthetical “when performed” language is intentional in the AMA descriptor. CPT 19083 bundles clip placement and specimen imaging when they occur; you still report the code correctly even if you omit either element for clinical reasons.

CPT code 19083 vs related breast biopsy codes (19081-19086)

Selecting the wrong imaging guidance code is the single most common denial trigger for breast biopsy claims. The 19081-19086 series maps one-to-one with guidance modality. Using CPT code 19083 when the surgeon performed the procedure under stereotactic guidance will produce a denial based on inconsistency between the operative report and the code billed.

Add-on code 19084: Additional lesions

When the same session involves ultrasound-guided biopsy of more than one lesion, report CPT 19083 for the first lesion and CPT 19084 for each additional lesion. You cannot report the add-on code without the parent code. Three lesions biopsied under ultrasound guidance in one session = one unit of 19083 plus two units of 19084.

Reporting 19083 three times instead is a bundling error that triggers a Correct Coding Initiative (CCI) edit. The same parent-plus-add-on logic governs localization outside the breast, where CPT 10036 covers each additional soft tissue site.

CPT 76942: Is ultrasound guidance separately billable?

The current AMA descriptor for CPT 76942 reads: Ultrasonic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device), imaging supervision and interpretation. CCI edits generally treat this service as bundled with CPT code 19083, because ultrasound guidance is already included in the 19083 descriptor.

Billing 76942 alongside 19083 for the same lesion will typically produce a denial. However, payer-specific policies vary and some carriers may allow separate billing under specific circumstances. Verify the applicable payer’s CCI edit status and policy before submitting.

Modifiers for CPT code 19083

Modifier selection for CPT 19083 depends on who performed which component of the procedure and where. Missing or incorrect modifiers are a top-five denial cause for breast biopsy claims. The table below covers the modifiers most commonly applied within the breast biopsy series.

CPT 19083 and the rest of the 19081-19086 family carry a Medicare Physician Fee Schedule PC/TC indicator of 0, meaning the code cannot be split into professional and technical components. Modifiers 26 and TC do not apply here – you bill the code globally regardless of who owns the imaging equipment.

Modifier 50 (bilateral procedure) does not apply either. When the surgeon biopsies both breasts under ultrasound guidance in the same session, report each additional lesion, including a contralateral one, with add-on code 19084 instead of modifier 50.

ICD-10 diagnosis codes used with CPT code 19083

Payers require a covered ICD-10 diagnosis code on every CPT 19083 claim to establish medical necessity. The accepted codes vary by Medicare Administrative Contractor (MAC) jurisdiction and by commercial payer. The list below reflects commonly accepted diagnoses based on CMS coverage guidance and representative LCD policies.

Verify your applicable MAC’s LCD before submission – presenting a code not on that LCD’s covered list is a direct denial path. For detailed crosswalk guidance, CrossCoder’s CPT-to-ICD-10 crosswalk tool can help identify payer-accepted diagnosis pairings.

• Z12.31 – Encounter for screening mammogram for malignant neoplasm of breast
• N63.0 – Unspecified lump in unspecified breast
• N63.10-N63.42 – Lump in breast, specified quadrant and laterality
• C50.x – Malignant neoplasm of breast (specific laterality and sub-site codes)
• D05.x – Carcinoma in situ of breast
• R92.8 – Other abnormal and inconclusive findings on diagnostic imaging of breast
• N60.x – Benign mammary dysplasia (select codes depending on payer policy)

Laterality is critical. If the biopsy is of the right breast, the ICD-10 code must reflect right-side specificity (e.g., N63.11 for upper outer quadrant, right breast). A generic or unspecified laterality code paired with a laterality modifier creates a mismatch that payers flag during automated edits.

Maintaining HIPAA-compliant documentation that clearly records lesion laterality from the imaging report through the operative note is the cleanest way to prevent this mismatch.

Documentation requirements for CPT code 19083

Insufficient documentation is the second most common reason payers deny CPT 19083 claims, after incorrect coding. According to AMA CPT guidelines, the operative report must support the procedure as described by the code – meaning every element of the 19083 descriptor needs a corresponding documentation element.

Using standardized medical forms and structured procedure note templates reduces the risk of missing required elements.

• Pre-procedure imaging: Reference to the imaging study (mammogram, prior ultrasound) that identified the target lesion, including the report date
• Lesion description: Location (quadrant), laterality, size, and imaging characteristics of the lesion to be biopsied
• Guidance modality confirmation: Explicit documentation that real-time ultrasound guidance was used during needle placement – “ultrasound-guided” must appear in the operative note
• Biopsy device type: Core needle vs. vacuum-assisted; gauge size if clinically relevant
• Clip/marker placement: If the radiologist placed a localization clip, document placement and confirm imaging verification of clip position
• Specimen handling: Number of cores obtained, specimen sent to pathology, pathology order number
• Post-procedure imaging: Documentation that specimen imaging was performed (if performed) or a clinical note explaining why it was omitted
• Medical necessity narrative: Why biopsy was indicated based on imaging findings – supports the ICD-10 diagnosis code on the claim

The most common documentation shortfall is the absence of an explicit statement confirming real-time ultrasound guidance. Coders cannot infer guidance modality from device type or setting – the note must state it explicitly. A billing compliance checklist built into the pre-submission workflow catches this before the claim goes out.

Medicare calculates reimbursement for CPT code 19083 using the Resource-Based Relative Value Scale (RBRVS). Medicare derives the national payment amount from three RVU components multiplied by the Medicare conversion factor, then adjusted by Geographic Practice Cost Indices (GPCIs) for the practice locality.

Rates change annually – the figures below reflect 2026 Medicare Physician Fee Schedule (MPFS) data; verify current national and locality-specific rates using the CMS Physician Fee Schedule lookup tool.

RVU breakdown for CPT 19083

The 2026 RVU values for CPT code 19083 reflect the work involved in performing and supervising an ultrasound-guided percutaneous breast biopsy. Use FastRVU’s 2026 RVU lookup tool to access current work, practice expense, and malpractice RVU values and calculate locality-adjusted payments. The table below shows the standard RVU component structure.

Facility vs. non-facility rates for CPT 19083

Non-facility rates for CPT code 19083 are meaningfully higher than facility rates. When the procedure is performed in a physician’s office or freestanding imaging center (Place of Service 11), Medicare reimburses at the non-facility rate because the physician’s practice bears the overhead.

When performed in a hospital outpatient department (Place of Service 22) or ambulatory surgical center (Place of Service 24), the facility rate applies and the hospital or ASC receives a separate facility payment through the outpatient prospective payment system.

Practice administrators managing surgical practice billing workflows need to confirm the place-of-service code on every 19083 claim matches the setting where the procedure was performed. A POS mismatch between the claim form and the facility’s records is an audit red flag and can result in recoupment demands during a Medicare review.

Medicare coverage policy for CPT code 19083

Medicare covers CPT code 19083 when the claim meets medical necessity criteria and includes a covered ICD-10 diagnosis code. Each Medicare Administrative Contractor governs coverage for ultrasound-guided breast biopsy through its general breast-biopsy Local Coverage Determination, not a single national policy.

CMS coverage article A57848 is sometimes cited in this context, but it specifically addresses tomosynthesis-guided biopsy – reported with unlisted code 19499 or with 19081 combined with stereotactic guidance – not ultrasound-guided 19083. Reviewing the applicable LCD for your MAC’s jurisdiction before seeing Medicare breast biopsy patients is the most reliable way to ensure coverage.

• Coverage requirement 1: Prior imaging (mammography, ultrasound, or MRI) must show the target lesion, and the medical record must document it
• Coverage requirement 2: The operative report or pre-procedure documentation must reference the imaging study that identified the lesion
• Coverage requirement 3: The ICD-10 code on the claim must appear on the MAC’s covered diagnosis list for the applicable LCD
• Coverage requirement 4: The imaging guidance modality stated in the claim must match the modality described in the operative report
• Common denial trigger: Submitting a Z-code (screening) as the primary diagnosis for a diagnostic or therapeutic biopsy – Z12.31 is appropriate only for screening-prompted procedures, not for biopsies of previously identified suspicious lesions

Pre-authorization requirements for CPT code 19083 vary by commercial payer and plan type. Some payers require prior authorization for breast biopsies; others do not. Verify with each individual payer before scheduling. Maintaining consistent patient data security and EHR integration across your pre-auth and billing workflows reduces the administrative burden of managing payer-specific requirements.

Build audit-ready breast biopsy documentation

Pabau helps radiology and surgical practices structure procedure notes, intake forms, and modifier documentation for CPT 19083 so records stay accurate and audit-ready.

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Common billing errors and denial reasons for CPT code 19083

Radiology billing publications consistently flag the same cluster of errors for percutaneous breast biopsy claims. Breast biopsy coding errors typically fall into six categories.

• Wrong guidance modality code: Billing 19083 when the operative report documents stereotactic or MRI guidance. The modality code must match the documentation exactly.
• Missing laterality modifier: Submitting CPT code 19083 without LT or RT modifier when the payer requires laterality. Most commercial payers and Medicare require explicit side identification.
• 76942 unbundling error: Separately billing CPT 76942 (ultrasound guidance) alongside 19083 for the same lesion. 19083 bundles imaging guidance, and CCI edits typically deny the additional code.
• Multiple units of 19083: Reporting 19083 x2 for two lesions instead of 19083 + 19084. Use the add-on code 19084 for each additional lesion beyond the first.
• Unsupported ICD-10 code: Using a diagnosis code not on the MAC’s LCD covered list, or using a screening code for a diagnostic procedure. Check the applicable LCD before submission.
• Missing real-time guidance documentation: The operative note does not explicitly state that the provider used ultrasound guidance in real time during needle placement. Coders cannot infer this from other documentation elements.

How billing software supports CPT code 19083 claims

Radiology, surgical, and OB-GYN practices billing CPT code 19083 regularly face the same set of preventable errors: wrong modifier, unsupported ICD-10 pairing, or an add-on code submitted without the parent code. Good practice management software catches these at the pre-submission stage rather than post-denial.

Pabau’s documentation tools give practice teams a structured workflow for recording procedure details, selecting the correct modifier based on billing setting, and confirming ICD-10 pairings before claims are submitted. Practices using digital intake and consent forms can prompt clinicians to confirm guidance modality and laterality at the point of documentation, keeping records audit-ready.

For teams building out their broader documentation infrastructure, compliance management tools help track LCD requirements by payer and flag potential issues before they reach the claims submission stage.

The AAPC’s CPT coding reference and the AMA’s coding resources remain the authoritative sources for CPT 19083 coding guidelines, but the operational layer – tracking modifier decisions, payer-specific rules, and documentation requirements at scale – is where billing software adds measurable value to a radiology or surgical billing team.

Conclusion

CPT code 19083 is one of the higher-reimbursing breast procedure codes in the radiology and surgical billing universe, which means payers scrutinize it closely. The denial patterns are consistent and preventable: wrong modality code, missing laterality, bundling errors with the add-on code, and documentation that doesn’t explicitly confirm ultrasound guidance.

Practices that build a CPT 19083 pre-submission checklist into their workflow, verify ICD-10 codes against the applicable LCD before submission, and train coders on the distinction between primary and add-on code usage see materially lower denial rates on these claims.

Pabau’s documentation workflows help practices structure procedure notes and intake forms so the right information reaches the claim form the first time and the file stays audit-ready if a payer requests records. To see how Pabau supports radiology and surgical billing teams, book a demo with our team.

Continue your research

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Need a diagnosis code for a musculoskeletal claim? ICD-10 code M46.1 covers sacroiliitis not elsewhere classified, with the same documentation-first denial pattern seen in breast biopsy claims.

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Frequently asked questions