CPT code 19105: Cryosurgical ablation of fibroadenoma

Key takeaways

CPT code 19105 covers cryosurgical ablation of a fibroadenoma, each fibroadenoma, with ultrasound guidance and monitoring already included.

Bill one unit per fibroadenoma treated, so three ablations in one session generate three units of 19105.

Ultrasound guidance is bundled into 19105, so a separate 76942 line triggers an automatic bundling denial.

Site of service moves this claim more than any modifier does, at roughly $194 in a facility versus $2,536 in an office.

Medicare’s multiple-procedure indicator for 19105 is 2, so each additional unit in the same session pays at 50%.

CPT code 19105 is cryosurgical ablation of a fibroadenoma, each fibroadenoma, including ultrasound guidance and monitoring. The procedure freezes a benign breast tumor in place rather than cutting it out. Ultrasound guidance is written into the descriptor, so it is never billed alongside the code.

This reference covers the descriptor, RVU components, Medicare payment in both settings, and the modifiers that apply. It also covers the ICD-10 pairings and the documentation an audit will ask for. Every figure below comes from CMS’s physician fee schedule relative value files.

CPT code 19105: Definition and clinical description

Cryoablation destroys a fibroadenoma with a probe cooled far below freezing. The physician positions the probe under ultrasound, forms an ice ball around the tumor, and watches the margin in real time. The tumor stays in the breast and is reabsorbed over the following months.

The phrase “each fibroadenoma” in the descriptor is the billing signal. Every tumor treated is a separate billable unit. A session that ablates two fibroadenomas generates two units of 19105.

CPT 19105 code details at a glance

RVU values for CPT 19105

Relative Value Units (RVUs) drive what the CMS Physician Fee Schedule pays for a procedure. On CPT 19105 the practice expense component differs enormously between settings. That single difference makes place of service the biggest variable on the claim.

The non-facility PE RVU of 71.34 carries the disposable cryoprobe and the office supplies. In a hospital or ambulatory surgery center the facility buys those items, so the physician’s PE RVU falls to 1.22. Values above are the national figures from CMS’s 2026 relative value files, before any Geographic Practice Cost Index adjustment.

Medicare reimbursement rate for CPT 19105

Medicare payment is total RVUs multiplied by the annual conversion factor. For CY2026 the conversion factor is $33.4009, rising to $33.5675 for practices in a qualifying alternative payment model. The estimates below use $33.4009 and no geographic adjustment.

That is a 13-fold spread on one code. A practice that brings fibroadenoma cryoablation into its own treatment room buys the cryoprobe and is paid for it. A practice that books the case into a hospital is paid for the professional work alone.

A second adjustment lands when several fibroadenomas are treated together. Medicare’s multiple-procedure indicator for 19105 is 2, so the highest-valued line pays in full and every additional line pays at 50%. In an office setting that reduction is worth more than $1,200 on a second unit.

Rates change every January 1 when CMS publishes the new fee schedule. Look up your own locality in the CMS fee schedule search tool rather than quoting the national figure to a provider. For procedure code fee schedules outside US Medicare, go to the payer portal directly.

Modifiers for CPT code 19105

Modifier choice on CPT code 19105 changes both the payment and the audit exposure. Medicare’s own indicators settle the laterality and bilateral questions outright. Commercial policy decides the rest, so check the payer before appending anything.

Billing guidelines for CPT 19105

Per-unit billing is the rule that matters most on this code. Each fibroadenoma treated in a session is a separate billable event. A surgeon who ablates three tumors should generate three units, not one. The note has to identify every fibroadenoma by location, size, and imaging confirmation.

• Do not bill ultrasound guidance separately. The descriptor already includes it, so a 76942 line produces a bundling denial. This is the most common error on the code.
• Expect a prior authorization requirement. Many commercial payers cover fibroadenoma cryoablation but will not pay without pre-authorization. Confirm it with each payer before the appointment is booked.
• Document medical necessity tumor by tumor. The note needs the imaging-confirmed diagnosis plus the size and location of each fibroadenoma. It also needs the reason a non-surgical approach was chosen and post-procedure confirmation of the ablation margin. Practices using digital intake forms can capture most of that while the patient is still in the room.
• Report the correct place of service. Facility versus non-facility changes the PE RVU and the payment by an order of magnitude. Billing the office rate for a hospital outpatient case invites overpayment recovery.
• Read the payer’s coverage policy first. Some commercial payers publish criteria for breast ablation, including a minimum tumor size. A Local Coverage Determination may also apply in your Medicare region.

What survives an audit is a record that says the same thing from the HIPAA-compliant clinical note through to the submitted claim. Procedure-heavy practices, including plastic surgery practices, get there by keeping tumor-level detail on one record instead of three.

ICD-10 diagnosis codes used with CPT 19105

The diagnosis codes paired with CPT code 19105 come from the D24 category, benign neoplasm of breast. Laterality has to match the procedure site. A right-side modifier against a left-side diagnosis code fails a simple edit check.

Related CPT codes to know

Knowing where 19105 sits in the breast code family helps when the clinical picture does not match a standard fibroadenoma ablation. The codes below are the ones coders reach for instead.

The bundling logic on 19105 is not unique to breast surgery. CPT code 10012 behaves the same way, with the imaging guidance written into the descriptor rather than billed beside it.

Per-lesion and size-based pricing runs through the excision families too. CPT code 11404 is priced on lesion diameter, and CPT code 11622 is priced on both site and size.

Common billing errors and how to avoid them

Four errors account for most CPT code 19105 denials. All four are caught by a short pre-submission check.

• Unbundling the imaging guidance. Billing 76942 alongside 19105 is the most frequent error. CMS’s National Correct Coding Initiative edits deny the imaging line automatically. Remove it before the claim goes out.
• An incorrect unit count. Reporting one unit when three fibroadenomas were treated leaves money on the table. Over-reporting units without tumor-level notes creates overpayment liability instead.
• A missing or mismatched laterality modifier. Submitting 19105 without -RT or -LT where the payer requires it produces a modifier denial. Submitting -RT against a note that documents the left breast raises a consistency flag.
• No prior authorization. Commercial payers often require pre-authorization for cryoablation. This is the most expensive error, because the resulting denial is usually not appealable.

Practices running claims management software with built-in bundling edits catch most of these before submission. A manual check depends on whichever coder happens to be working that day.

Payer coverage policies for cryoablation of fibroadenoma

Medicare generally covers CPT code 19105 where medical necessity is documented, but commercial coverage varies a lot. Some payers treat fibroadenoma cryoablation as a standard breast procedure benefit. Others set a minimum tumor size, commonly 1 cm, or ask for a note that the patient declined surgical excision.

• Medicare: Covered under the Physician Fee Schedule when medically necessary and properly documented. No National Coverage Determination addresses 19105 at the time of publication, so a Local Coverage Determination from your Medicare Administrative Contractor may apply instead.
• Highmark: Highmark Medical Policy Bulletin S-164-003 addresses breast cryoablation. Check the current version each time, because these bulletins are reissued periodically.
• BCBS and other commercial payers: Criteria vary by plan, and some still treat cryoablation as investigational below a size threshold. Verify the active policy before the encounter rather than after the denial.

Practices with a mixed payer book need somewhere to track authorization status per payer. That is where dermatology EMR software and similar specialty tools earn their keep. The AAPC code lookup is a quick way to check medical necessity edits and LCD summaries tied to 19105.

How Pabau keeps per-unit 19105 claims accurate

In most practices this claim crosses three systems before it reaches the payer. The surgeon’s note sits in the chart. The unit count gets retyped into a billing screen, and the modifier is added by whoever prepares the batch. Each hand-off is somewhere a unit can go missing.

Practice management software like Pabau holds the note, the code, the units, and the modifier on one patient record. When the surgeon documents two fibroadenomas, two units carry through to the claim without anyone keying them again. Laterality comes from the same note, so -RT never lands on a left-breast case.

That matters on a code where denials are almost always administrative rather than clinical. If you are still comparing systems, look at how billing depth differs across practice management software before you commit to one.

Fewer denials on per-unit codes like 19105

Pabau keeps the procedure note, the CPT code, the unit count, and the modifier on one record. Your coders stop retyping units between systems, so fewer claims come back.

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Conclusion

CPT code 19105 is simple to describe and easy to underbill. The unit count, the bundled imaging, the laterality modifier, and the place of service each decide a slice of the payment.

The decision worth revisiting is where the procedure happens. Medicare pays roughly $194 in a facility and roughly $2,536 in an office, because the office buys the cryoprobe. Settle that question first, then work down to the modifiers.

After that, everything rests on whether the note and the claim say the same thing about every tumor treated. Book a demo to see how Pabau carries tumor-level documentation straight through to a clean claim.

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