Summary & Overview
CPT 19105: Ultrasound-Guided Cryoablation of Breast Fibroadenoma
CPT code 19105 covers ultrasound-guided percutaneous cryoablation of a breast fibroadenoma, a minimally invasive procedure that destroys a benign solid breast tumor using a cryoprobe. This code is relevant nationally as clinicians and payers evaluate options that may offer less-invasive alternatives to surgical excision for selected patients with symptomatic or biopsy-proven fibroadenomas. The code signals clinical intent (image-guided ablative therapy) and is important for billing, coverage policy development, and procedure tracking.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context and typical sites of service, payer coverage considerations, common modifiers, and guidance on documentation elements linked to the service description. The publication summarizes benchmarks and policy updates where available and highlights areas where explicit payer guidance or national coding consensus may be limited.
The report is intended for clinicians, coding professionals, and policy analysts seeking concise information on coding and clinical context for image-guided percutaneous cryoablation of breast fibroadenomas. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 19105 describes a percutaneous cryoablation of a breast fibroadenoma performed under ultrasound guidance. The procedure uses a cryoprobe to destroy a solid, benign breast tumor (fibroadenoma) with image guidance to ensure accurate targeting.
Service type: Image-guided percutaneous ablative procedure
Typical site of service: Outpatient procedure setting, commonly performed in an ambulatory surgery center or hospital outpatient department with ultrasound guidance and local or regional anesthesia.
Clinical & Coding Specifications
Clinical Context
A 34-year-old woman presents with a palpable, well-circumscribed breast mass previously proven by core needle biopsy to be a benign fibroadenoma. The mass measures 1.8 cm on diagnostic ultrasound and the patient requests a minimally invasive, cosmetically favorable option for lesion removal. The breast surgeon schedules an outpatient ultrasound-guided cryoablation procedure using a cryoprobe under local anesthesia with conscious sedation as needed. The clinical workflow includes pre-procedure imaging confirmation and consent, time-out and sterile preparation in an ambulatory surgery center or hospital outpatient department, ultrasound localization of the target lesion, percutaneous cryoprobe insertion, two freeze–thaw cycles to ablate the fibroadenoma under real-time ultrasound visualization, post-procedure hemostasis and dressing, brief recovery monitoring, and discharge with return precautions and follow-up arranged for imaging at 3–6 months.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier — default status | Use when no specific modifier applies to the claim. |
11 | Primary procedure | Use when this cryoablation is the primary procedure performed during the encounter. |
22 | Increased procedural services | Use when the procedure required substantially greater work than typical (e.g., unusually complex localization or prolonged time). |
26 | Professional component | Use when billing only the professional (physician) component separate from the facility or technical component. |
50 | Bilateral procedure | Use when both breasts are treated in the same session and payer allows bilateral reporting for this service. |
52 | Reduced services | Use when the procedure was partially reduced or not completed as planned (e.g., aborted due to patient intolerance). |
53 | Discontinued procedure | Use when the procedure was started but discontinued for patient safety reasons. |
62 | Two surgeons | Use when two surgeons work together as primary surgeons performing distinct portions of the procedure. |
78 | Unplanned return to OR for related procedure by same physician | Use when the patient requires an unplanned, same-day return to address a complication related to the cryoablation. |
80 | Assistant surgeon | Use when an assistant surgeon performs services and the payer accepts assistant surgeon modifiers. |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services | Use when a qualifying non-physician practitioner bills under their own NPI for allowable services. |
QX | CRNA service with anesthesiologist absent | Use when a certified registered nurse anesthetist (CRNA) furnishes anesthesia without medical direction by an anesthesiologist and separate CRNA billing rules apply. |
QY | Medical direction of one CRNA by physician | Use when a physician medically directs one CRNA providing anesthesia for the procedure. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207XS0127X | Female Pelvic Medicine & Reconstructive Surgery | Breast procedures occasionally performed by surgeons with breast-focused training; included as a potential performer. |
207X00000X | General Surgery | Most common surgical specialty performing percutaneous breast procedures and minimally invasive excisions. |
207XP0016X | Plastic Surgery | Performs procedures when cosmetic considerations or oncoplastic approaches are needed. |
207RC0000X | Radiology, Diagnostic | Interventional radiologists frequently perform image-guided percutaneous cryoablations. |
363L00000X | Physician Assistant | Commonly assists in clinic, procedure room, and peri-procedural care. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
D24.9 | Benign neoplasm of breast, unspecified | Directly relevant — fibroadenoma is a benign breast neoplasm often coded to D24 variants when site is unspecified. |
N63 | Unspecified lump in breast | Used when a palpable breast lump is documented prior to definitive histologic diagnosis or when localization is primary. |
R92.8 | Other abnormal and inconclusive findings on diagnostic imaging of breast | Applied when imaging finds an abnormality requiring percutaneous treatment or further management. |
Z48.02 | Encounter for removal of surgical wound dressing; not routinely used but available for post-procedural care | Used for documented follow-up wound or dressing management after percutaneous procedures when indicated. |
Z51.81 | Encounter for therapeutic drug administration | Used when peri-procedural therapeutic agents are administered and require coding for the encounter context. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
76942 | Ultrasonic guidance for needle placement (e.g., for diagnostic or therapeutic injection) | Performed to localize the fibroadenoma and guide cryoprobe placement under real-time ultrasound. |
19083 | Biopsy, percutaneous, breast, with placement of needle-localization device(s) when performed; with imaging guidance | May precede cryoablation if a prior core biopsy or localization is required in the same session. |
20550 | Injection(s); single tendon sheath, or ligament, or trigger point — therapeutic (included as example of injection code) | Local anesthetic or corticosteroid injections are rarely used peri-procedurally for pain control; included only when adjunctive injections occur. |
99213 | Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes | Commonly used for pre-procedure evaluation or post-procedure follow-up visits in the outpatient setting. |
36415 | Collection of venous blood by venipuncture | Performed when laboratory testing (e.g., coagulation studies) is obtained pre-procedure. |