CPT 19086: MR-Guided Percutaneous Breast Biopsy, Additional Lesion

CPT code 19086 denotes an MR-guided percutaneous breast biopsy performed for each additional separately reportable lesion after the first; placement of a localization device may be done at the same time. This code matters nationally because MR-guided breast biopsy is a specialized image-guided service used when lesions are occult on mammography or ultrasound and require high-resolution MR targeting. Accurate coding affects site-of-service reporting, utilization tracking, and payment for complex breast imaging procedures.

Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for MR-guided breast biopsy, common payment and coding considerations, and typical sites where the service is delivered. The publication summarizes how 19086 is used to report additional lesions beyond the first, the potential inclusion of a localization device at the same encounter, and implications for claim reporting and service lines.

The analysis provides national benchmarks and policy context where available, highlights payer coverage patterns, and clarifies the clinical scenarios in which MR-guided percutaneous breast biopsy is selected. Data not provided in the input are noted explicitly as unavailable.

Billing Code Overview

CPT code 19086 describes a percutaneous breast biopsy performed under magnetic resonance (MR) guidance for each additional separately reportable lesion after the first. The descriptor indicates the provider may also place a localization device at the same encounter.

Service type: Image-guided percutaneous breast biopsy for additional lesion(s) under MR guidance
Typical site of service: Outpatient imaging centers, hospital outpatient departments, or ambulatory surgery centers where MR-guided breast procedures are performed

Data not available in the input.

Clinical Context

A 52-year-old woman with an area of suspicious enhancement on surveillance breast MRI is scheduled for MRI-guided percutaneous breast biopsy. Prior diagnostic imaging detected two spatially separate enhancing lesions in the same breast; the first lesion will be biopsied under MRI guidance and the second lesion will be sampled and reported separately using CPT code 19086. The procedure is performed in an outpatient imaging center or hospital radiology suite equipped with MRI biopsy capability. The workflow includes informed consent, MRI localization, placement of an MRI-compatible biopsy device and sampling of targeted lesion tissue, optional placement of a localization clip or marker at the time of biopsy, hemostasis, and post-procedure monitoring with discharge instructions. The typical patient is positioned prone in an MRI biopsy coil; the radiologist performs image-guided targeting, acquires tissue cores from the additional lesion, documents laterality and number of lesions, and communicates findings and specimen labeling to pathology.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the physician professional component separate from technical services.
`50`

Taxonomy Code	Specialty	Notes
207RC0000X	Diagnostic Radiology	Radiologists commonly perform MRI-guided breast biopsies.
207RN0400X	Vascular & Interventional Radiology	Interventional radiologists perform image-guided breast interventions.
207RH0002X	Radiology – Breast Imaging	Breast imaging subspecialists perform targeted MRI-guided biopsies.
363L00000X	Obstetrics & Gynecology (Breast Surgery)	Breast surgeons may perform or coordinate image-guided localization and biopsy planning.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`N63`	Unspecified lump in breast	Common presenting finding prompting MRI-guided biopsy of suspicious lesions.
`R92.8`	Other abnormal and inconclusive findings on diagnostic imaging of breast	MRI-detected abnormal enhancement often leads to targeted biopsy.
`C50.919`	Malignant neoplasm of unspecified site of unspecified female breast	Biopsy is performed to confirm or exclude breast cancer when imaging is suspicious.
`D05.90`	Unspecified diagnosis of ductal carcinoma in situ of breast	Biopsy may identify in situ carcinoma requiring further management.
`N64.4`	Mastodynia (breast pain)	Occasionally associated with imaging workup leading to biopsy when correlated with lesions.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`19083`	Biopsy, breast, with placement of catheter or localization device, when performed; first lesion under MRI guidance	Often billed for the initial MRI-guided breast lesion biopsy; `19086` is used for each additional lesion.
`19085`	Biopsy, breast, with placement of localization device, when performed; first lesion under stereotactic guidance	Alternate guidance modality; relevant when lesion localization uses stereotactic rather than MRI guidance.
`19125`	Excision of breast lesion identified by preoperative placement of radiological marker	May follow biopsy if surgical excision is required after diagnosis.
`77046`	Magnetic resonance guidance for needle placement, breast	May be reported for MRI guidance during needle placement depending on payer policy and technical reporting rules.
`76942`	Ultrasonic guidance for needle placement	Used when ultrasound is used for targeting additional lesions or post-MRI correlation to guide sampling.

OpenPayer

Summary & Overview