Summary & Overview
CPT 10036: Image-Guided Add-On Localization Device
CPT code 10036 denotes an add-on, image-guided percutaneous localization in which an additional tiny metallic or radioactive marker is placed through the skin to mark suspicious tissue for later surgery or radiation. It is performed at the same session as the initial localization for the first lesion and uses live imaging such as fluoroscopy or ultrasound to ensure accurate placement. This procedure is clinically important because precise localization improves surgical targeting and radiation planning, reducing treatment margins and potentially improving outcomes.
Key payers covered in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of billing context and clinical use, typical sites of service, and common modifiers used with this add-on code. The publication outlines national reimbursement and policy considerations relevant to facilities and providers who perform image-guided localization procedures, and clarifies how this add-on is reported relative to the initial localization service.
The article also provides practical benchmarks and policy updates affecting billing and coding for image-guided localization, along with clinical context that informs appropriate reporting. Data not available in the input is noted where necessary.
Billing Code Overview
CPT code 10036 is an add-on localization procedure in which the provider places an additional tiny metallic or radioactive device into a patient’s body through a needle inserted through the skin to mark the exact location of suspicious tissue for a subsequent surgical procedure or radiation treatment. The provider uses fluoroscopy or ultrasound imaging to guide the needle and places this additional localization device at the same session as the initial device for the first lesion.
Service type: Image-guided percutaneous localization (add-on procedure)
Typical site of service: Outpatient imaging suite, hospital radiology department, or ambulatory surgical center, where fluoroscopy or ultrasound guidance is available.
Clinical & Coding Specifications
Clinical Context
A 58-year-old woman with a newly detected suspicious breast lesion on diagnostic mammography and targeted ultrasound is scheduled for surgical excision. At an image-guided localization session, an interventional radiologist places a radioactive seed or tiny metallic marker through a percutaneous needle into the lesion to mark its precise location for the subsequent lumpectomy. The procedure is performed in an outpatient radiology suite or ambulatory surgery center using fluoroscopic or ultrasound guidance. The provider confirms placement with real-time imaging, documents laterality and number of devices placed (this add-on 10036 applies when an additional localization device is placed for a second lesion at the same session), and communicates device type and location to the surgical team. Typical workflow: pre-procedure consent and site verification → ultrasound/fluoroscopy localization and placement of device(s) → post-placement imaging confirmation and documentation → transfer of patient to surgical scheduling with device details and specimen handling instructions.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Office or outpatient visit | When reporting an evaluation and management visit that is tied to the procedure under payer rules |