Summary & Overview
CPT 19084: Ultrasound-Guided Percutaneous Breast Biopsy, Additional Lesion
CPT code 19084 covers ultrasound-guided percutaneous breast biopsy for each additional separately reportable lesion after the first; placement of a localization device may be performed at the same encounter. This procedure code is important for accurate reporting of multi-lesion breast biopsy encounters and for distinguishing payment and resource use when multiple sites within the same breast are sampled. Nationally, correct use of CPT code 19084 supports clinical documentation, procedure tracking, and consistent claims adjudication for outpatient imaging and procedural settings.
Key payers addressed in this publication include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical context and coding intent, typical sites of service, and common modifiers used with this code. The analysis highlights benchmark considerations for multiple-lesion procedures, billing scenarios involving same-day localization, and documentation elements that support separate reporting for additional lesions. Policy updates, payer-specific payment nuances, and comparative benchmarks are summarized to aid coding, revenue cycle, and clinical teams in aligning documentation with billing practices. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 19084 describes a percutaneous breast tissue biopsy procedure performed under ultrasound guidance for each additional separately reportable lesion after the first. The provider may place a localization device at the same time.
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Service type: Image-guided percutaneous breast biopsy for additional lesion(s)
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Typical site of service: Outpatient imaging suite or outpatient surgical/procedure center where ultrasound-guided breast biopsies are performed
Clinical & Coding Specifications
Clinical Context
A 52-year-old woman presents to the breast imaging center after screening mammography and diagnostic ultrasound identify two separate suspicious lesions in the right breast. The patient is scheduled for image-guided percutaneous core needle biopsy of both lesions under ultrasound guidance during the same encounter. The procedural workflow includes pre-procedure consent and targeted ultrasound to localize each lesion, sterile preparation, local anesthesia, and percutaneous biopsy of the first lesion (reported with the primary biopsy CPT). The provider then repositions the probe to the second lesion and performs an additional ultrasound-guided percutaneous breast tissue biopsy for the separate lesion, which is reported with 19084. A clip or localization device may be deployed at the time of biopsy of the additional lesion. Specimens are labeled separately and sent to pathology. The procedure typically occurs in an outpatient breast imaging suite, ambulatory surgery center, or hospital outpatient department with monitoring during recovery and post-procedure instructions provided prior to discharge.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the physician interpretation/professional portion of the procedure and the technical component is billed separately. |
59 | Distinct procedural service | Use when another service on the same day is performed on a separate lesion or clearly distinct service requiring separate reporting; supports separate lesion reporting when appropriate. |
76 | Repeat procedure by same physician | Use when the same service is repeated later the same day by the same physician on a different lesion when documentation supports a repeat procedure. |
77 | Repeat procedure by another physician | Use when the same service is repeated later the same day by a different physician on a different lesion. |
50 | Bilateral procedure | Use when the additional lesion biopsy is performed on the contralateral breast and bilateral reporting is appropriate per payer rules. |
51 | Multiple procedures | Use when multiple procedures are reported on the same day; some payers require this modifier on secondary procedure codes. |
52 | Reduced services | Use when the procedure was partially reduced or not completed as documented (e.g., aborted biopsy of the additional lesion). |
53 | Discontinued procedure | Use when the procedure was started but discontinued for patient safety reasons prior to completion. |
TC | Technical component | Use when billing only the technical component (equipment, facility, nonphysician staff) and the professional component is billed separately. |
26 | Professional component | (Included above) See first row for guidance. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207RH0000X | Radiology — Diagnostic Radiology | Radiologists commonly perform ultrasound-guided breast biopsies and localization. |
207RR0500X | Radiology — Vascular & Interventional Radiology | Interventional radiologists perform percutaneous breast biopsies and localization in complex cases. |
170100000X | Surgery — General Surgery | General surgeons with breast specialty training perform image-guided breast biopsies in some settings. |
207K00000X | Obstetrics & Gynecology | Gynecologic surgeons or breast-focused OB/GYNs may perform breast lesion biopsies in certain practices. |
208M00000X | Surgery — Surgical Oncology | Breast surgical oncologists perform and coordinate diagnostic biopsies and subsequent localization for surgical planning. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
R92.8 | Other abnormal and inconclusive findings on diagnostic imaging of breast | Documents abnormal imaging findings prompting targeted biopsy of additional lesion(s). |
N63 | Unspecified lump in breast | Common clinical presentation leading to imaging and percutaneous biopsy of one or more lesions. |
N60.9 | Benign mammary dysplasia, unspecified | Benign breast disease that may require biopsy to exclude malignancy. |
C50.919 | Malignant neoplasm of unspecified site of unspecified female breast | Malignancy found or suspected in the breast prompting biopsy and localization for diagnosis and treatment planning. |
D48.6 | Neoplasm of uncertain behavior of breast | Used when imaging or initial pathology yields uncertainty about behavior, indicating need for targeted biopsies. |
R92.1 | Mammographic microcalcifications | Imaging finding that often leads to targeted biopsy of multiple suspicious areas. |
R92.0 | Mammographic abnormality, unspecified | General imaging abnormality prompting diagnostic workup with image-guided biopsy. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
19081 | Biopsy, breast, percutaneous, with image guidance, first lesion, including placement of localization device when performed | Represents the primary code for the first lesion; 19084 is used for each additional separate lesion after this primary code. |
19085 | Breast biopsy, percutaneous, each additional lesion observed with stereotactic guidance | Used when additional lesions are sampled using stereotactic rather than ultrasound guidance; analogous to 19084 for stereotactic technique. |
19295 | Breast localization, placement of localization device(s) (e.g., wire, radioactive seed) | Used when localization for surgical excision is performed as a separate procedure or when localization is performed without concurrent biopsy. |
76942 | Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device) | Use when billing separately for ultrasound guidance if payer requires separate reporting for guidance when not bundled into the biopsy code. |
10021 | Fine needle aspiration; without imaging guidance | Performed in some diagnostic workflows for cytology; different technique and reporting than core needle biopsy codes above. |