Summary & Overview
CPT 19302: Partial Mastectomy with Axillary Lymphadenectomy
CPT code 19302 is a critical billing code for partial mastectomy procedures with axillary lymphadenectomy, widely used in the surgical management of breast cancer. This code encompasses the excision of breast tissue—such as lumpectomy, tylectomy, quadrantectomy, or segmentectomy—combined with the removal of axillary lymph nodes, a key step in cancer staging and treatment. The procedure is most often performed in outpatient hospital settings, reflecting current clinical practice trends.
Major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare, recognize and reimburse for CPT code 19302, underscoring its importance in both clinical and billing workflows. The code is associated with a range of ICD-10 diagnoses, such as malignant neoplasms and carcinoma in situ of the breast, and is relevant to multiple physician specialties, including surgical oncology, general surgery, and related fields.
Readers will gain insight into the clinical context of partial mastectomy with axillary lymphadenectomy, payer coverage details, and related coding benchmarks. The publication also highlights common modifiers used for billing, associated taxonomies, and related CPT codes for comprehensive breast surgery and lymph node procedures. This overview provides a foundation for understanding national policy updates, reimbursement trends, and clinical best practices for breast cancer surgery.
CPT Code Overview
CPT code 19302 describes a partial mastectomy procedure, which includes the removal of a portion of breast tissue—such as a lumpectomy, tylectomy, quadrantectomy, or segmentectomy—along with an axillary lymphadenectomy. This surgical intervention is typically performed to treat breast cancer or other breast conditions requiring both tissue excision and lymph node assessment. The service type is surgical procedure – breast surgery, and it is most commonly conducted in an outpatient hospital setting (Place of Service 22).
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves a female patient diagnosed with breast cancer or carcinoma in situ, presenting for surgical management. The patient is scheduled for a partial mastectomy (such as lumpectomy, tylectomy, quadrantectomy, or segmentectomy) with axillary lymphadenectomy to assess lymph node involvement. The procedure is performed in an outpatient hospital setting. The clinical workflow includes preoperative evaluation, surgical excision of the breast lesion, removal of axillary lymph nodes, and postoperative care. This approach is commonly used for patients with localized breast malignancy or carcinoma in situ, where axillary lymph node assessment is indicated.
Coding Specifications
| Modifier Code | Description | Usage Scenario |
|---|---|---|
50 | Bilateral Procedure | Used when the procedure is performed on both breasts. |
LT | Left Side | Used when the procedure is performed on the left breast. |
RT | Right Side | Used when the procedure is performed on the right breast. |
59 | Distinct Procedural Service | Used when a distinct procedure is performed that is not normally reported together. |
Associated Provider Taxonomies:
208600000X– Surgery Physician (General Surgery)207N00000X– Dermatology Physician207RG0100X– Gastroenterology Physician207RH0003X– Surgical Oncology Physician207RI0200X– Vascular Surgery Physician
These taxonomies represent specialties commonly involved in breast surgery and related procedures.
Related Diagnoses
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C50.911– Malignant neoplasm of unspecified site of right female breast- Indicates a cancer diagnosis in the right breast, clinically relevant for partial mastectomy with axillary lymphadenectomy.
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C50.912– Malignant neoplasm of unspecified site of left female breast- Indicates a cancer diagnosis in the left breast, relevant for surgical excision and lymph node assessment.
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D05.11– Lobular carcinoma in situ of right breast- Represents a non-invasive carcinoma in the right breast, for which partial mastectomy and lymph node evaluation may be indicated.
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D05.12– Lobular carcinoma in situ of left breast- Represents a non-invasive carcinoma in the left breast, relevant for surgical management and lymph node assessment.
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Z85.3– Personal history of malignant neoplasm of breast- Indicates a history of breast cancer, which may warrant surgical intervention for recurrence or new lesions.
Related CPT Codes
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19301– Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy)- Used for partial mastectomy procedures without axillary lymphadenectomy. Often an alternative to
19302when lymph node removal is not performed.
- Used for partial mastectomy procedures without axillary lymphadenectomy. Often an alternative to
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19307– Mastectomy, modified radical, including axillary lymph nodes, with or without pectoralis minor muscle, but excluding pectoralis major muscle- Represents a more extensive mastectomy with axillary lymph node removal. Used when a modified radical approach is indicated.
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38500– Biopsy or excision of lymph node(s); open, superficial- Used for open biopsy or excision of superficial lymph nodes. May be performed in conjunction with breast surgery for diagnostic purposes.
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38525– Biopsy or excision of lymph node(s); open, deep axillary node(s)- Used for excision of deep axillary lymph nodes. Can be performed alongside breast procedures for further lymph node assessment.
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38745– Axillary lymphadenectomy; complete- Used for complete removal of axillary lymph nodes. May be reported when a full axillary dissection is performed.
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38900– Intraoperative identification (eg, mapping) of sentinel lymph node(s) includes injection of non-radioactive dye, when performed (List separately in addition to code for primary procedure)- Used for intraoperative mapping of sentinel lymph nodes. Commonly reported in addition to breast surgery codes when sentinel node identification is performed.