CPT code 19302: Partial mastectomy with axillary lymph node dissection

Key takeaways

CPT code 19302 covers a partial mastectomy performed with axillary lymph node dissection, so use 19301 when no dissection takes place.

Work RVU for 19302 is about 13.6 and total RVU is about 25.9 under the 2026 CMS Physician Fee Schedule.

Billing 38525 alongside 19302 triggers NCCI bundling edits, because the axillary dissection already sits inside the 19302 descriptor.

Practice management software like Pabau ties the operative note to the claim, so coders see the documentation behind every 19302 charge.

The official AMA CPT code set descriptor for 19302 is: Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy); with axillary lymph node dissection.

This code applies when a surgeon removes part of the breast and dissects the axillary lymph nodes in the same session. The procedure carries several clinical synonyms, depending on how much tissue comes out and which approach the surgeon uses.

The axillary lymph node dissection (ALND) is what separates 19302 from its neighbors. Without a documented ALND, a different code applies. Breast oncology cases vary widely in scope, so the operative note has to name every component the surgeon performed.

CPT 19301 vs CPT 19302: Key differences

CPT 19301 and CPT 19302 describe the same partial mastectomy procedure. The only distinction is the axillary lymph node component.

The most common 19301 vs 19302 error is selecting 19302 when only a sentinel node biopsy was performed. Sentinel node biopsy belongs with 19301, reported separately as 38500 or 38525, and never justifies moving up to 19302.

ICD-10 diagnosis codes that support the procedure

Medical necessity for 19302 requires a supporting ICD-10-CM diagnosis code on the claim. Most pairings come from the C50 breast malignancy category. Benign or uncertain neoplasm codes apply in narrower clinical scenarios. Confirm the physician’s documented diagnosis before you select a code.

Specificity matters here. Payers and Medicare Administrative Contractors (MACs) flag C50.9xx codes when the operative note names a discrete tumor location. Use the most granular code the record supports, such as C50.411 for an upper-outer quadrant tumor in the right breast. For a patient returning after completed treatment, Z85.3 records the personal history instead of an active malignancy.

Modifiers that belong on the claim

Modifier selection depends on laterality, surgical complexity, and whether several procedures happened in the same operative session. Incorrect modifier use is a common audit trigger for breast surgery claims.

Modifier -22 claims draw extra scrutiny. The operative note has to show what made the case harder than a standard 19302. Extensive scarring from prior surgery, morbid obesity affecting access, and a technically difficult axillary dissection all qualify. Without that detail, the payer will deny the upward adjustment.

RVU values and work units

The Medicare Physician Fee Schedule assigns relative value units to 19302 across three components. CMS updates these figures every year, so check current values in the CMS fee schedule lookup before you bill.

Both columns match because 19302 is an operating-room procedure. CMS prices no separate office-based rate for it, so the same total applies wherever the surgery happens. Watch for older reference tables that show an inflated non-facility practice expense, because that figure does not reflect the current schedule.

Reimbursement rates and the 2026 fee schedule

Medicare pays for 19302 by multiplying total RVUs by the annual conversion factor, then applying geographic adjustments through the Geographic Practice Cost Index (GPCI). The finalized 2026 conversion factor is $33.40 for practices outside a qualifying alternative payment model. Practices inside a qualifying model get $33.57.

Run the math for a facility case and 25.9 total RVUs multiplied by $33.40 gives roughly $865. That puts the national unadjusted estimate in the $860 to $870 range. High-cost metro localities such as San Francisco and New York land above it, while rural localities land below. Confirm your own locality in the CMS lookup before you quote a figure to a patient or payer.

• Rates above are estimates based on publicly available CMS data, and they do not represent guaranteed reimbursement
• Commercial payer rates for 19302 are usually negotiated as a percentage of the Medicare allowable, and vary widely by contract
• Prior authorization requirements depend on the individual payer and plan type, so confirm with each payer before scheduling
• ASC reimbursement for 19302 follows the separate ASC payment system, which is distinct from the physician fee schedule

Medicare coverage and policies

Medicare covers 19302 for a medically necessary indication, most commonly malignant breast neoplasm. Coverage runs through Local Coverage Determinations (LCDs) issued by individual MACs rather than one national policy. Criteria, documentation requirements, and prior authorization expectations therefore differ between MAC jurisdictions.

• Medical necessity documentation: Pathology has to confirm or strongly suggest malignancy. Another clinically accepted indication also works, such as locally advanced disease needing surgical management
• LCD review: Check your MAC’s LCD for 19302, or the broader mastectomy LCD family, before billing. LCD requirements can include specific ICD-10 code lists, surgical technique documentation, and node count minimums
• NCCI edits: The National Correct Coding Initiative (NCCI) governs which codes can be billed together. CPT 38525 is bundled with 19302 and cannot be billed separately without a modifier and strong justification. Check the current NCCI edit files before you submit both
• Global surgical period: CPT 19302 carries a 90-day global surgical period. Post-operative visits inside those 90 days are generally included in the procedure payment

High-value surgical codes attract post-payment review, so a recoupment demand on 19302 can arrive months after payment. Building the LCD check and the NCCI check into your revenue cycle steps keeps that risk down.

Documentation requirements for axillary lymph node dissection

The operative note is the single most important document behind a 19302 claim. Never assign the code without checking that the note describes the axillary dissection as a distinct step. A note covering only the breast resection does not support 19302, whatever the surgeon intended.

Breast cases reach coders from more than one specialty. A plastic surgery practice and an OB-GYN practice can both submit 19302, and both need the same ALND language in the note.

• Explicit ALND language: The note has to say “axillary lymph node dissection”, “axillary lymphadenectomy”, or a comparable descriptor. “Lymph node removal” and “sentinel node biopsy” do not qualify
• Node count: Document how many nodes were removed and sent to pathology. An ALND typically removes 10 or more nodes, while a sentinel node biopsy removes one to five
• Pathology report correlation: The pathology report should confirm receipt and examination of axillary lymph node tissue, with node count and any involvement recorded
• Anatomical extent: Note the levels of axillary dissection (Level I, II, or III) when the surgeon documents them. That detail supports medical necessity on audit
• Laterality: The note has to specify which side was operated on, consistent with the laterality modifier on the claim

A practice using clinical record management tools that store structured operative notes has less to chase when a payer asks for support. Set a retention rule too, because record retention periods decide how long that note stays available.

Storage matters as much as content. HIPAA compliance rules require that operative records stay secure and retrievable for audit, which rules out a shared drive nobody owns.

Common coding errors and compliance pitfalls

CPT 19302 appears on payer audit lists more often than most codes in the 19000 series. These are the mistakes coders make most:

• Upcoding 19301 to 19302: Selecting 19302 when the note documents only a sentinel node biopsy is the most common error. A sentinel node biopsy does not qualify as axillary lymph node dissection for coding purposes
• Unbundling 38525 with 19302: Billing 38525 separately alongside 19302 triggers NCCI bundling edits. The ALND is already included in 19302 and should not be coded twice
• Missing laterality modifier: Submitting 19302 without -RT or -LT means a denial from most payers. This is a technical error you can prevent at claim creation
• Insufficient modifier -22 justification: Appending -22 without a written justification letter and supporting note detail is a compliance risk. Some carriers treat unsupported -22 claims as fraud
• 90-day global period overlap: An E/M service inside the 90-day global period gets bundled automatically. Append -24, -25, or -57 when the visit covers a clearly unrelated condition

The AAPC CPT code library lists NCCI edit pairs for surgical codes, including the 19302 and 38525 pairing. Checking those pairs before submission is a standard step for any surgical billing team.

Related CPT codes in the breast surgery range

CPT 19302 sits in a family of breast surgery codes. Knowing the adjacent codes helps when an operative report describes work that straddles a code boundary.

Codes from the same breast family often appear in one surgical episode. Preoperative localization runs through 19286 when ultrasound guidance is used, and 19125 covers excision after a radiological marker is placed.

Diagnostic and adjuvant work sits nearby as well. 19083 reports the ultrasound-guided biopsy that confirmed the malignancy, and 19297 covers catheter placement for brachytherapy during the same session.

How claims management software keeps 19302 claims defensible

In most surgical practices the operative note, the pathology report, and the claim live in three different systems. A coder opens the note, counts nodes, checks the modifier, then retypes the code into billing. Every hop is a chance for 19302 to go out without the ALND language behind it.

Pabau keeps all three in one patient record. Claims management pulls the code, the laterality modifier, and the diagnosis straight from the note the surgeon signed, so nothing gets retyped. Coders review the claim next to the documentation that supports it.

That matters most when a payer asks for support months later. The note, the node count, the pathology, and the submitted claim sit together, so a records request takes minutes instead of days.

Connect operative notes to clean surgical claims

Pabau links the signed operative note to the claim, so coders can confirm ALND documentation, laterality, and diagnosis before 19302 goes out. That means fewer denials and less rework for the billing team.

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Conclusion

The judgment call on 19302 is almost always the same one. Read the operative note and decide whether a full axillary dissection took place. If the note describes a sentinel node biopsy, 19301 plus 38500 or 38525 is the honest answer.

Fixing the code after a denial costs far more than reading the note carefully the first time. Set the check up once, at the point where the coder opens the claim, and the same decision stops coming back.

Book a demo to see how Pabau ties surgical documentation to claim submission, so 19302 goes out with the note that supports it.

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