Summary & Overview
CPT 19301: Partial Mastectomy (Lumpectomy)
Headline: Partial Mastectomy CPT 19301: Key Clinical and Payer Context
Lead: CPT 19301 identifies partial mastectomy procedures—commonly called lumpectomy, tylectomy, quadrantectomy, or segmentectomy—used to remove a discrete portion of breast tissue for malignant or in situ breast disease. This code is central to breast-conserving surgical management and frequently appears in surgical oncology workflows.
What this code represents and why it matters: CPT 19301 denotes a breast-conserving surgical procedure that can affect subsequent treatment planning, quality metrics, and episode-of-care costs. Nationally, partial mastectomy is a common alternative to total mastectomy when oncologically appropriate, making accurate coding important for clinical records, care coordination, and payer adjudication.
Key payers covered: Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare are considered in this publication.
Overview of content: Readers will find a concise overview of the code’s clinical context, common billing modifiers and coding relationships, typical settings of care, and related CPT entries used in axillary staging or more extensive breast resections. The publication highlights coding boundaries versus more comprehensive mastectomy procedures, common ICD-10 diagnosis pairings used to justify medical necessity, and related procedure codes often billed in the same episode of care.
What readers will learn: practical coding distinctions for breast-conserving surgery, alignment with common diagnosis codes, and how CPT 19301 fits alongside related procedures such as axillary node operations and modified radical mastectomy. Data not available in the input regarding specific payer policies or reimbursement benchmarks is noted where applicable.
CPT Code Overview
CPT 19301 describes a partial mastectomy procedure, commonly referred to as lumpectomy, tylectomy, quadrantectomy, or segmentectomy. This CPT code captures surgical removal of a portion of breast tissue for diagnostic or therapeutic purposes.
Service Type: Surgical Procedures on the Breast (Mastectomy Procedures)
Typical Site of Service: Outpatient Hospital (POS 22)
Clinical & Coding Specifications
Clinical Context
A patient presents to an outpatient hospital surgical clinic with a suspicious breast mass identified on imaging and confirmed by core needle biopsy as malignant or ductal carcinoma in situ. The surgical team (often a surgical oncologist or breast surgeon) schedules a breast-conserving operative procedure coded as 19301 (partial mastectomy, eg, lumpectomy, quadrantectomy) performed in an outpatient hospital setting (POS 22). Preoperative workflow includes history and physical, imaging review, anesthesia evaluation, and marking of the lesion; intraoperative steps include excision of the targeted breast tissue with margin assessment and hemostasis; postoperative workflow includes pathology submission of the specimen, post-anesthesia recovery, and surgical follow-up with discussion of pathology results and any need for additional therapy.
Coding Specifications
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Common Modifiers and Use
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50— Bilateral Procedure: Applied when the same partial mastectomy procedure (19301) is performed on both breasts during the same operative session. -
LT— Left Side: Applied when the procedure19301is performed on the left breast to designate laterality. -
RT— Right Side: Applied when the procedure19301is performed on the right breast to designate laterality. -
59— Distinct Procedural Service: Applied when another procedure performed during the same encounter is distinct and separate from the partial mastectomy (for example, a separate unrelated procedure at a different anatomic site or a distinct service not normally performed together). -
Associated Provider Taxonomies and Specialties
| Taxonomy Code | Specialty |
|---|---|
208600000X | Surgery Physician |
207N00000X | Dermatology Physician |
207RG0100X | Gastroenterology Physician |
207RH0003X | Surgical Oncology Physician |
207RI0200X | Vascular Surgery Physician |
- Clinical note: apply laterality modifiers (
LT/RT) when documentation clearly states side; use50only if bilateral same-session procedure is documented. Use59sparingly and support with operative report detail showing distinctness of services.
Related Diagnoses
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C50— Malignant neoplasm of breastThe diagnosis
C50denotes invasive breast cancer, which is a primary clinical indication for performing a partial mastectomy (19301) when breast-conserving surgery is appropriate. -
D05— Carcinoma in situ of breastThe diagnosis
D05denotes breast carcinoma in situ (eg, ductal carcinoma in situ), which can be an indication for breast-conserving procedures such as a partial mastectomy (19301) for local excision of the in situ lesion.
Related CPT Codes
| CPT Code | Description |
|---|---|
19302 | Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy); with axillary lymphadenectomy |
38525 | Biopsy or excision of lymph node(s); open, deep axillary node(s) |
19307 | Mastectomy, modified radical, including axillary lymph nodes, with or without pectoralis minor muscle, but excluding pectoralis major muscle |
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19302: Represents a partial mastectomy performed with concurrent axillary lymphadenectomy. Clinically,19302is used when formal removal of axillary lymph nodes is performed in the same operative setting rather than separate sampling. -
38525: Represents open deep axillary lymph node biopsy or excision. This may be performed as a separate or concurrent procedure when sampling or targeted removal of axillary nodes is required; it can be used in combination with19301when documented as a distinct service. -
19307: Represents a more extensive operation (modified radical mastectomy) removing the entire breast and axillary nodes. Clinically,19307is an alternative to19301when disease extent or surgical planning requires full mastectomy rather than breast-conserving partial mastectomy. -
Common usage notes:
19302and38525are commonly used together with or instead of19301depending on need for axillary evaluation.19307is an alternative procedure when oncologic indications require a more extensive resection.
National Reimbursement Benchmarks
National commercial averages are materially higher than Medicare reimbursement for 19301. The BUCA composite mean of $881.34 sits well above the Medicare mean of $639.80, indicating commercial payers on average reimburse several hundred dollars more than Medicare for this code.
Dispersion of allowed rates varies by payer. UnitedHealth Group and Cigna show the widest interquartile spreads (UHC: $1,370.00 - $680.00 = $690.00; Cigna: $1,258.00 - $644.50 = $613.50), indicating greater variability. Medicare is the tightest ($665.00 - $614.00 = $51.00), followed by Aetna and BCBS with moderate spreads (Aetna: $395.00; BCBS: $377.37). The table and chart below present the full breakdown.
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