CPT Code 19285: Breast Localization Device Placement Guide

Key takeaways

CPT Code 19285 covers percutaneous placement of a breast localization device in the first lesion, and ultrasound guidance is bundled into the code.

Never bill a separate imaging guidance code such as 76942 alongside 19285, because payers will deny the duplicate line.

Report 19286 for each additional lesion localized under ultrasound in the same session.

NCCI edits decide whether 19285 can be reported with an excision code like 19125, so check the current edit pair before filing.

Practice management software like Pabau helps billing teams pair codes accurately and submit cleaner claims.

CPT Code 19285 covers percutaneous placement of a breast localization device in the first lesion, with ultrasound guidance included in the code. The device can be a clip, a metallic pellet, a wire or needle, or a radioactive seed.

Because the guidance is already bundled, a separate imaging code on the same claim will be denied. Reporting 76942 alongside 19285 is the most common way this claim goes wrong.

This reference covers the AMA descriptor, the modifiers payers expect, NCCI bundling rules, Medicare payment, and the documentation that supports the claim. It is written for radiology and surgical oncology billing teams.

The AMA descriptor, element by element

According to the American Medical Association (AMA), the official owner of the CPT code set, the full descriptor reads:

Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including ultrasound guidance.

Several elements of that descriptor carry direct billing implications. The table below breaks each one down.

CPT Code 19285 sits in the Introduction Procedures on the Breast section of the CPT code set. Radiologists, breast surgeons, and surgical oncologists use it to localize non-palpable breast lesions before surgery or diagnosis.

Breast localization code family: CPT 19281, 19283, 19285, and 19286 compared

The four codes in this family are separated by imaging modality and by whether the procedure covers the first lesion or an additional one. Picking the wrong code for the imaging used is a common denial trigger.

When several lesions are localized under ultrasound in one session, bill 19285 once for the first lesion. Report 19286 for every lesion after that. It is an add-on code, so it cannot be billed without 19285 as the primary.

Placement during a biopsy is billed differently. When the device goes in as part of an ultrasound-guided biopsy, 19083 and 19084 apply instead of the localization codes.

Procedures performed under a different imaging modality in the same session use their own primary codes. Mammographic guidance is 19281 and stereotactic guidance is 19283. Each modality is a distinct clinical setup and a distinct billable service.

Modifiers that apply to CPT Code 19285

Modifiers tell the payer about the clinical circumstances around the procedure. Three categories apply most often to CPT Code 19285.

Inappropriate modifier use is one of the top audit triggers for breast localization claims. Document the clinical scenario that justifies each modifier before you append it. The AAPC CPT code reference organizes further modifier guidance by procedure category.

When to report 19285 separately: NCCI edits and bundling rules

The National Correct Coding Initiative (NCCI) governs whether CPT Code 19285 can appear on the same claim as an excision code. The question comes up most often when a radiologist performs the localization and a surgeon performs the excision.

CPT 19285 and CPT 19125: Reporting together

CPT 19125 covers excision of a breast lesion identified by a preoperative radiological marker. It is the code most often paired with 19285 in breast-conserving surgery.

• Different physician, same date of service: When the radiologist places the device and a different surgeon performs the excision, both codes are usually separately reportable. Each provider bills their own service on their own claim.
• Same physician, same session: When one physician places the device and performs the excision in a single session, bundling rules generally apply. Check the current NCCI edits before reporting both codes.
• Modifier 59 unbundling: If the edits create a column 1 / column 2 pair for 19285 and 19125, modifier 59 may document a distinct procedural service. Use it only when the documentation supports it, and confirm the edit status before filing.

NCCI edits change with each quarterly update. Coders should check current edit pairs in the CMS Physician Fee Schedule and NCCI resources before finalizing claims. Incorrect unbundling creates overpayment exposure and audit risk.

Additional lesion reporting: CPT 19286

When one ultrasound-guided session involves more than one lesion, report 19285 for the first lesion and CPT 19286 for each additional lesion. The claim must match the number of lesions documented in the imaging report.

• 19285 + 19286 x1 = two lesions localized under ultrasound
• 19285 + 19286 x2 = three lesions localized under ultrasound
• Do not report 19286 without 19285 on the same claim
• Document each lesion’s location and device type separately in the imaging report

Watch the modality when you reach for an add-on code. 19286 is the ultrasound add-on. 19287 is a primary code for a first lesion placed under MRI guidance, so it never pairs with 19285.

HCPCS device codes required under OPPS

Hospital outpatient facilities bill under the Outpatient Prospective Payment System (OPPS), and that carries one extra requirement. A claim for 19285 must include a companion HCPCS device code. CMS applies this under its device-intensive procedure policy.

The specific HCPCS code depends on the device manufacturer and the product used. Common device categories include:

• Radioactive seeds: Hologic and other manufacturers publish product-specific HCPCS codes for their radioactive seed localization devices. Check the manufacturer’s reimbursement guide for the exact code.
• Wire and needle devices: Some wire localization systems have associated HCPCS pass-through codes under OPPS. Confirm the code with the device supplier.
• Clip and metallic pellet devices: These may need a device HCPCS code under the CMS device pass-through payment policy, depending on the product category.

Device HCPCS codes are also revised and retired over time. C1720 is one that CMS has deleted, so a code that cleared last year may not clear now.

A missing companion device code is one of the main denial reasons for hospital outpatient breast localization claims. Physician office settings billing under the Medicare Physician Fee Schedule do not carry the requirement. Confirm the code with your device manufacturer’s reimbursement team before you submit.

Medicare reimbursement rates for 19285 in 2026

Medicare payment for CPT Code 19285 is calculated using the Resource-Based Relative Value Scale (RBRVS). The allowed amount reflects three RVU components: work, practice expense, and malpractice. Each is multiplied by a geographic adjustment factor and the annual conversion factor.

Rates change every year and vary by locality, so the figures below are reference benchmarks. Verify current amounts in the CMS Physician Fee Schedule lookup tool, or in the FastRVU 2026 RVU lookup for your own locality.

Facility vs non-facility payment rates

CPT Code 19285 pays differently depending on where the procedure happens. Facility rates apply in a hospital outpatient department or an ambulatory surgical center. Non-facility rates apply in a physician office.

For 2026 national average dollar amounts, use the PCC free 2026 RVU calculator, which draws on CMS data files. Enter locality code 99 for the national average. Payment localities move the allowed amount a long way in high-cost regions such as California, New York, and Alaska.

Commercial payer reimbursement

Commercial payers negotiate rates independently of the Medicare Physician Fee Schedule. Contracted rates for CPT Code 19285 vary widely by payer and region.

• Prior authorization: Some commercial payers require prior authorization for breast localization, particularly for non-emergency pre-operative cases. Check payer policy before scheduling.
• Contracted rate: Your contract with each payer governs payment, not the Medicare rate. Review your contracts or use your clearinghouse’s fee schedule comparison tools.
• Coverage policies: Coverage criteria for specific localization technologies vary by payer. Some insurers restrict radioactive seed localization through local coverage determinations.

Documentation requirements for a 19285 claim

Thin documentation is the second most common denial reason after bundling errors. The imaging report and the operative note together must establish medical necessity and confirm each element of the procedure.

Required documentation elements for CPT Code 19285 include:

• Ultrasound guidance: The radiology report must confirm that real-time ultrasound guidance was used throughout the placement. That wording also removes any basis for billing a separate guidance code.
• Device type and quantity: Record which device was placed and how many went in. This matters most in multi-lesion cases that use more than one modality.
• Lesion count and location: Identify each lesion by clock position, distance from the nipple, and depth. This is what supports add-on code 19286 when you report it.
• Pre-operative indication: Say why localization was clinically necessary. Biopsy-confirmed malignancy, a suspicious imaging finding, and pre-operative planning all qualify.
• Post-placement imaging: An image confirming correct device position supports medical necessity. Some payers ask for it as proof that the procedure was completed.

Digital intake and procedure forms that capture these elements at the point of care stop problems that only surface weeks after the service date. HIPAA-compliant documentation practices also require that imaging reports and operative notes be stored and transmitted securely.

Common billing errors and denial prevention

These are the failure points behind most breast localization denials, with the check that prevents each one.

ICD-10 diagnosis code crosswalk

CPT Code 19285 must be paired with an ICD-10-CM diagnosis code that establishes the clinical indication for localization. The diagnosis should reflect the confirmed or suspected condition that prompted the procedure.

Code to the highest specificity the chart supports. For a malignant finding that means naming the side and the quadrant, so C50.411 rather than an unspecified breast code. Falling back on a vague code when the documentation is specific is a common audit finding.

How practice management software supports 19285 billing

Breast localization billing has several moving parts, and every one of them is a place where a claim can slip:

• Code pairing across two providers
• An NCCI edit check before submission
• OPPS device code requirements on facility claims
• Documentation that matches across the radiology and surgical records

Handled by hand, each handoff between the imaging suite and the billing desk is a chance for something to go missing.

Practice management software like Pabau puts all of it in one workflow. Pabau’s claims management software records the procedure, pairs the diagnosis code, and applies the right modifiers before the claim goes out.

Structured client records hold the imaging report, operative note, device documentation, and consent in one place. A coder can then validate a 19285 claim without switching systems.

Breast localization also sits between specialties. A plastic surgery EMR keeps the reconstruction record in the same system as the billing. OB-GYN software does the same on the referring side. The claim is then built from one set of notes rather than three.

Tired of breast localization claim rejections?

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Conclusion

Breast localization coding rewards a habit more than a rulebook. Read the imaging report first, count the lesions, then choose the code that matches the modality actually used. Most of the work is done before anyone opens the claim.

The expensive denials are the quiet ones. A missing device code on a facility claim, or an NCCI pair nobody checked, will not announce itself until the remittance arrives. Both cost far less to catch in review than in appeal.

Pabau’s claims management software supports code pairing, structured documentation, and modifier validation for breast surgery and radiology billing teams. Book a demo to see how it fits into your claim review.

Continue your research

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Frequently asked questions