Summary & Overview
CPT 19303: Simple, Complete Mastectomy Procedure
CPT code 19303 represents a simple, complete mastectomy, a critical surgical intervention for patients with breast cancer and other serious breast conditions. This procedure is widely performed across the United States and is a cornerstone of breast cancer treatment protocols. The code is recognized by major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare, ensuring broad coverage and reimbursement for providers and facilities.
This publication provides a comprehensive overview of CPT code 19303, including its clinical context, typical site of service, and payer coverage. Readers will gain insights into national benchmarks, policy updates, and the procedural landscape for mastectomy services. The analysis also highlights relevant modifiers, associated taxonomies, and common ICD-10 diagnoses linked to this code, offering a clear understanding of its role in surgical oncology and breast health management. By examining payer policies and clinical guidelines, the article equips stakeholders with essential information for navigating the complexities of medical billing and coding for mastectomy procedures.
CPT Code Overview
CPT code 19303 describes a simple, complete mastectomy, a surgical procedure involving the removal of all breast tissue without axillary lymph node dissection. This procedure is typically performed for patients with breast cancer or other significant breast conditions. The service type is Surgical – Mastectomy Procedures, and the most common site of service is the inpatient hospital setting (Place of Service 21). This code is central to surgical oncology and breast surgery practices nationwide.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an adult female diagnosed with breast cancer or a suspicious breast lesion. The patient is admitted to an inpatient hospital setting for a surgical procedure. The clinical workflow includes preoperative assessment, imaging, and consultation with a surgical oncologist or general surgeon. The procedure performed is a simple, complete mastectomy (19303), which entails removal of all breast tissue without axillary lymph node dissection. Postoperative care includes monitoring for complications, pain management, and coordination with oncology for further treatment if indicated.
Coding Specifications
| Modifier Code | Description | Usage Scenario |
|---|---|
| RT | Right side | Used when the mastectomy is performed on the right breast |
| LT | Left side | Used when the mastectomy is performed on the left breast |
| 50 | Bilateral procedure | Used when mastectomy is performed on both breasts during the same operative session |
| 59 | Distinct procedural service | Used when a distinct or separate mastectomy procedure is performed, not normally reported together |
Associated Provider Taxonomies:
208600000X– Surgery Physician (General Surgery)2086S0122X– Surgical Oncology Physician (Surgical Oncology)208800000X– Plastic Surgery Physician (Plastic Surgery)