Summary & Overview
CPT 19085: MRI-Guided Percutaneous Breast Biopsy with Localization
CPT code 19085 represents an MRI-guided percutaneous breast biopsy of a single lesion, with the option to place a localization device during the same procedure. This image-guided diagnostic intervention is an important tool in breast cancer diagnosis, enabling targeted tissue sampling when lesions are best visualized with magnetic resonance imaging. Nationally, MRI-guided breast biopsy addresses cases where mammography or ultrasound are insufficient, supporting earlier and more accurate diagnosis for patients with MRI-only lesions.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The analysis covers coding context, typical sites of service, and common billing modifiers. Readers will find concise benchmarks on payer coverage patterns, clinical indications that commonly drive use of this code, and notes on documentation elements linked to appropriate coding. The publication also outlines operational considerations for facilities performing MRI-guided breast biopsies, including site-of-service implications and the dual role of biopsy with concurrent localization.
This summary is intended for a national audience of practice managers, billing professionals, and clinical leaders who need a clear, concise reference to CPT code 19085, its clinical application, and payer landscape. Data not available in the input is noted where relevant.
Billing Code Overview
CPT code 19085 describes a percutaneous breast biopsy performed under magnetic resonance guidance. Under this service, the provider obtains breast tissue from a single lesion using MRI localization and imaging guidance. The description indicates that the clinician may also place a localization device at the same encounter.
Service type: Image-guided percutaneous breast biopsy (MRI-guided)
Typical site of service: Hospital outpatient department or freestanding radiology/ambulatory surgery center with MRI capability, where magnetic resonance guidance and percutaneous breast biopsy procedures are performed.
Clinical & Coding Specifications
Clinical Context
A 48-year-old woman with a suspicious enhancing mass identified on diagnostic breast MRI is referred for image-guided tissue diagnosis. She has no active infection or bleeding diathesis and has provided informed consent. On the day of service the patient is positioned prone on the MRI table with the breast immobilized in a dedicated coil. An MRI sequence localizes the target lesion, and a percutaneous biopsy approach is planned. Under magnetic resonance guidance the radiologist advances a biopsy needle into the single lesion and obtains core tissue samples. At the same session the provider may deploy a marker or localization device to guide future surgical excision if pathology is malignant or discordant. The typical site of service is an outpatient imaging center or hospital outpatient department with MRI biopsy capability. The clinical workflow includes pre-procedure history and coagulation review, MRI localization and targeting, tissue acquisition, optional placement of a localization marker, post-procedure imaging to confirm marker position, recovery and discharge instructions, and pathology processing of specimens.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the physician’s interpretation or procedural work separate from technical facility resources. |
50 | Bilateral procedure | Use when separate biopsies are performed on both breasts and payer allows bilateral modifier application. |
51 | Multiple procedures | Use when multiple CPT procedures are billed on the same date and payer requires a multiple procedure modifier. |
52 | Reduced services | Use when the service is partially reduced or not completed as described by the code (eg, aborted biopsy). |
53 | Discontinued procedure | Use when the procedure is terminated due to extenuating circumstances prior to completion. |
59 | Distinct procedural service | Use when another procedure/service on the same day is distinct and separate from the MRI-guided biopsy. |
62 | Two surgeons | Use when two surgeons of differing specialties work together as primary surgeons during the procedure (rare for percutaneous biopsy). |
73 | Discontinued outpatient hospital/ASC procedure prior to anesthesia | Use if procedure is discontinued after patient preparation but before anesthesia/medication for sedation. |
74 | Discontinued outpatient hospital/ASC procedure after administration of anesthesia | Use if procedure is discontinued after anesthesia has been administered. |
76 | Repeat procedure by same physician | Use when the same physician repeats the biopsy/procedure during the postoperative period. |
77 | Repeat procedure by another physician | Use when a second physician repeats the biopsy/procedure during the postoperative period. |
GA | Waiver of liability statement on file (patient requested or elective) | Use when a voluntary ABN or equivalent waiver applies for an item or service not paid by Medicare. |
TC | Technical component | Use when billing only the technical component (equipment, facility) of the MRI-guided biopsy. |
LT | Left side | Use to denote procedure performed on the left breast when laterality reporting is required. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207Q00000X | Diagnostic Radiology | Most common specialty performing MRI-guided breast biopsy and localization. |
| 2080P0206X | Interventional Radiology | Performs image-guided percutaneous breast interventions including MRI guidance in some centers. |
| 207R00000X | Surgery - General | Breast surgeons may coordinate localization placement and subsequent excision after biopsy result. |
| 207RP1001X | Surgical Oncology | Breast surgical oncologists involved when biopsy indicates malignancy requiring operative management. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
N63 | Unspecified lump in breast | Common indication for targeted MRI-guided biopsy when a discrete lesion is identified. |
R92.8 | Other abnormal and inconclusive findings on diagnostic imaging of breast | MRI-detected findings requiring tissue diagnosis. |
R92.0 | Mammographic microcalcifications | When calcifications are better localized with MRI correlation and biopsy is needed. |
C50.912 | Malignant neoplasm of unspecified site of left female breast | Biopsy may confirm malignancy and guide staging and treatment. |
C50.911 | Malignant neoplasm of unspecified site of right female breast | Same as above for right-sided lesions. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
19301 | Mastectomy, partial (partial mastectomy, lumpectomy) | Performed if biopsy and imaging confirm malignancy requiring surgical excision following localization. |
19083 | Biopsy, breast, with placement of breast localization device, imaging guidance; stereotactic | Alternative image-guided percutaneous biopsy technique when stereotactic rather than MRI guidance is used. |
77046 | Magnetic resonance guidance for needle placement (eg, for biopsy, aspiration, localization); percutaneous | Imaging guidance code that may be reported for MRI guidance elements depending on payer bundling rules. |
19281 | Breast localization, placement of localization device, percutaneous, for guidance of excision of breast lesion | Placement of localization device alone is used when marker placement is required without concurrent biopsy. |
G0296 | Image-guidance for breast biopsy, percutaneous, MRI guidance (Medicare-specific) | Medicare or payer-specific add-on/alternative codes used in some billing systems for MRI-guided breast biopsy procedures. |