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CPT 19020: Mastotomy with Exploration and Drainage of Deep Breast Abscess

CPT code 19020 represents a surgical mastotomy with exploration and/or drainage of a deep breast abscess. This procedure code is used to document incision and drainage when a provider surgically accesses a deep-seated abscess within breast tissue. Nationally, accurate coding for drainage procedures carries significance for clinical recordkeeping, appropriate site-of-service designation, and claims adjudication for acute breast infections.

Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication summarizes how 19020 is applied across care settings, typical clinical indications, and where it commonly appears on surgical service lines.

Readers will find concise benchmarks and context for coding and billing of 19020, clinical scenarios that commonly generate the code, and policy-relevant points affecting coverage and site-of-service decisions. When payer-specific rules are discussed, the focus is on nationally applicable considerations rather than state-level policies. Data not available in the input is noted where applicable.

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Billing Code Overview

CPT code 19020 describes a mastotomy with exploration and/or drainage of a deep abscess of the breast. The service involves making an incision into the breast tissue to locate, irrigate, and drain a localized deep abscess.

Service Type: Surgical drainage procedure (breast abscess drainage/exploration)

Typical Site of Service: Operative suite, ambulatory surgery center, or hospital inpatient setting depending on clinical severity and patient needs

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CPT 19020: Mastotomy with Exploration and Drainage of Deep Breast Abscess

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Billing Code Overview

Service Type: Surgical drainage procedure (breast abscess drainage/exploration)

Typical Site of Service: Operative suite, ambulatory surgery center, or hospital inpatient setting depending on clinical severity and patient needs

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult or lactating woman presenting to the emergency department or breast clinic with progressive breast pain, localized erythema, fluctuance, and fever. Imaging (breast ultrasound) demonstrates a deep-seated breast abscess not amenable to simple office needle aspiration. The clinical workflow includes triage and evaluation, targeted ultrasound-guided assessment, informed consent, preoperative antibiotics as indicated, local or monitored anesthesia, performance of a mastotomy with exploration and drainage of the deep abscess, placement of a drain if required, wound packing or irrigation, and short-term postoperative follow-up for wound care and culture-guided antibiotic management. Procedure documentation includes indication, operative findings (abscess size, location, depth), anesthesia type, drain placement, estimated blood loss, complications, and instructions for wound care and return precautions. Typical sites of service are the emergency department, ambulatory surgical center, or hospital operating room depending on abscess complexity and patient comorbidity. Common patient scenarios include lactational mastitis progressing to an abscess, postpartum breast infection, or deep nonlactational infectious collections in patients with diabetes or immunosuppression requiring operative drainage.

Coding Specifications

Modifier	Description	When to Use
`11`	Professional component	Use when reporting the physician’s professional portion for services that have distinct professional and technical components, if applicable to imaging or interpretation tied to the procedure.
`22`	Increased procedural services	Use when the procedure required substantially greater work than usual due to extensive exploration, multiloculated abscess, or significant debridement.
`23`	Unusual anesthesia	Use when general anesthesia or deep sedation is required for a procedure ordinarily performed with local anesthesia.
`52`	Reduced services	Use when the procedure is partially reduced or not completed (e.g., aborted mastotomy due to instability).
`53`	Discontinued procedure	Use when the procedure is started but discontinued due to patient condition or unforeseen circumstances.
`59`	Distinct procedural service	Use to indicate a separately identifiable procedure or service distinct from other services on the same day (e.g., separate incision and drainage on contralateral breast).
`62`	Two surgeons	Use when two surgeons work together as primary surgeons for a complex breast procedure.
`66`	Surgical team	Use when a surgical team approach is medically necessary for a complex case.
`78`	Unplanned return to OR by same physician following initial procedure for related procedure during the postoperative period	Use when the patient returns to the operating room emergently for recurrent or residual abscess drainage.
`79`	Unrelated procedure or service by the same physician during the postoperative period	Use when an unrelated procedure is performed during the global period.
`LT`	Left side	Use to report laterality when the procedure is performed on the left breast.
`RT`	Right side	Use to report laterality when the procedure is performed on the right breast.
`50`	Bilateral procedure	Use when both breasts are treated and the payer requires bilateral reporting rather than two separate line items.
`XU`	Unusual non-overlapping service (Distinct procedural service)	Use as a more specific modifier to indicate a service that is distinct and not overlapping with another service when payer accepts modifier.

Taxonomy Code	Specialty	Notes
`207Q00000X`	General Surgery	General surgeons commonly perform incision and drainage of deep breast abscesses in operative settings.
`207P00000X`	Plastic and Reconstructive Surgery	Plastic surgeons may be involved for complex debridement or closure when tissue loss or reconstruction is required.
`207V00000X`	Vascular Surgery	Data not directly applicable; included for completeness only.
`208M00000X`	Obstetrics & Gynecology	OB/GYN clinicians frequently manage lactational breast infections and may perform drainage in select settings.
`363L00000X`	Emergency Medicine	Emergency physicians often provide initial procedural drainage or arrange operative management for acute deep breast abscesses.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`N61.0`	Acute mastitis	Represents infectious inflammation of the breast that can progress to abscess requiring drainage.
`N61.1`	Chronic mastitis	Chronic inflammatory conditions that may form recurrent or deep abscesses needing operative management.
`N63`	Unspecified lump in breast	Palpable mass that may represent an abscess when associated with infection; often part of initial differential.
`N64.2`	Cavernous lymphangioma of breast / Other specified disorders of breast (use clinically appropriate code)	Represents structural breast disorders that can complicate infections; included for complex cases.
`E11.9`	Type 2 diabetes mellitus without complications	Diabetes is a common comorbidity that increases risk of complicated or recurrent breast abscesses and may affect healing.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`19020`	Mastotomy; exploration and/or drainage of a deep abscess in the breast	Primary procedure described.
`19000`	Puncture aspiration of breast cyst, single or multiple, with or without imaging guidance	May be performed before escalation to `19020` for accessible superficial abscesses or diagnostic aspiration.
`19001`	Puncture aspiration of breast abscess; percutaneous, including imaging guidance	Alternative minimally invasive approach for abscess drainage when feasible.
`12032`	Repair, intermediate, wounds of face, ears, eyelids, nose, lips; 2.5 cm to 7.5 cm	For closure of incision sites if more complex layered closure is needed after drainage (site-specific analogous codes used for breast).
`30140`	Drainage of deep abscess (e.g., neck) — example of drainage procedure codes for complex anatomic areas	Related code family for drainage procedures; demonstrates analogous billing when complexity requires different site coding.
`49320`	Unilateral diagnostic thoracoscopy	Included as an example of operative exploration services; not directly related but reflects operative exploration billing when additional procedures are required.

Related Codes

CPT-19000-BREAST-CYST-NEEDLE-ASPIRATION

CPT 19000: Needle Aspiration of Breast Cyst

CPT-19001-ADD-ON-PERCUTANEOUS-CYST-ASPIRATION-ADDITIONAL-CYST

CPT 19001: Add-on Puncture Aspiration of Additional Cyst

CPT-19030-BREAST-DUCTOGRAM-GALACTOGRAM-CONTRAST-INJECTION

CPT 19030: Mammary Ductogram/Galactogram Contrast Injection

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

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Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`11`	Professional component	Use when reporting the physician’s professional portion for services that have distinct professional and technical components, if applicable to imaging or interpretation tied to the procedure.
`22`	Increased procedural services	Use when the procedure required substantially greater work than usual due to extensive exploration, multiloculated abscess, or significant debridement.
`23`	Unusual anesthesia	Use when general anesthesia or deep sedation is required for a procedure ordinarily performed with local anesthesia.
`52`	Reduced services	Use when the procedure is partially reduced or not completed (e.g., aborted mastotomy due to instability).
`53`	Discontinued procedure	Use when the procedure is started but discontinued due to patient condition or unforeseen circumstances.
`59`	Distinct procedural service	Use to indicate a separately identifiable procedure or service distinct from other services on the same day (e.g., separate incision and drainage on contralateral breast).
`62`	Two surgeons	Use when two surgeons work together as primary surgeons for a complex breast procedure.
`66`	Surgical team	Use when a surgical team approach is medically necessary for a complex case.
`78`	Unplanned return to OR by same physician following initial procedure for related procedure during the postoperative period	Use when the patient returns to the operating room emergently for recurrent or residual abscess drainage.
`79`	Unrelated procedure or service by the same physician during the postoperative period	Use when an unrelated procedure is performed during the global period.
`LT`	Left side	Use to report laterality when the procedure is performed on the left breast.
`RT`	Right side	Use to report laterality when the procedure is performed on the right breast.
`50`	Bilateral procedure	Use when both breasts are treated and the payer requires bilateral reporting rather than two separate line items.
`XU`	Unusual non-overlapping service (Distinct procedural service)	Use as a more specific modifier to indicate a service that is distinct and not overlapping with another service when payer accepts modifier.

Taxonomy Code	Specialty	Notes
`207Q00000X`	General Surgery	General surgeons commonly perform incision and drainage of deep breast abscesses in operative settings.
`207P00000X`	Plastic and Reconstructive Surgery	Plastic surgeons may be involved for complex debridement or closure when tissue loss or reconstruction is required.
`207V00000X`	Vascular Surgery	Data not directly applicable; included for completeness only.
`208M00000X`	Obstetrics & Gynecology	OB/GYN clinicians frequently manage lactational breast infections and may perform drainage in select settings.
`363L00000X`	Emergency Medicine	Emergency physicians often provide initial procedural drainage or arrange operative management for acute deep breast abscesses.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`N61.0`	Acute mastitis	Represents infectious inflammation of the breast that can progress to abscess requiring drainage.
`N61.1`	Chronic mastitis	Chronic inflammatory conditions that may form recurrent or deep abscesses needing operative management.
`N63`	Unspecified lump in breast	Palpable mass that may represent an abscess when associated with infection; often part of initial differential.
`N64.2`	Cavernous lymphangioma of breast / Other specified disorders of breast (use clinically appropriate code)	Represents structural breast disorders that can complicate infections; included for complex cases.
`E11.9`	Type 2 diabetes mellitus without complications	Diabetes is a common comorbidity that increases risk of complicated or recurrent breast abscesses and may affect healing.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`19020`	Mastotomy; exploration and/or drainage of a deep abscess in the breast	Primary procedure described.
`19000`	Puncture aspiration of breast cyst, single or multiple, with or without imaging guidance	May be performed before escalation to `19020` for accessible superficial abscesses or diagnostic aspiration.
`19001`	Puncture aspiration of breast abscess; percutaneous, including imaging guidance	Alternative minimally invasive approach for abscess drainage when feasible.
`12032`	Repair, intermediate, wounds of face, ears, eyelids, nose, lips; 2.5 cm to 7.5 cm	For closure of incision sites if more complex layered closure is needed after drainage (site-specific analogous codes used for breast).
`30140`	Drainage of deep abscess (e.g., neck) — example of drainage procedure codes for complex anatomic areas	Related code family for drainage procedures; demonstrates analogous billing when complexity requires different site coding.
`49320`	Unilateral diagnostic thoracoscopy	Included as an example of operative exploration services; not directly related but reflects operative exploration billing when additional procedures are required.

Related Codes

CPT-19000-BREAST-CYST-NEEDLE-ASPIRATION

CPT 19000: Needle Aspiration of Breast Cyst

CPT-19001-ADD-ON-PERCUTANEOUS-CYST-ASPIRATION-ADDITIONAL-CYST

CPT 19001: Add-on Puncture Aspiration of Additional Cyst

CPT-19030-BREAST-DUCTOGRAM-GALACTOGRAM-CONTRAST-INJECTION

CPT 19030: Mammary Ductogram/Galactogram Contrast Injection

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

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CPT 19020: Mastotomy with Exploration and Drainage of Deep Breast Abscess

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Billing Code Overview

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CPT 19020: Mastotomy with Exploration and Drainage of Deep Breast Abscess

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References