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CPT 19110: Excision of Single Lactiferous Duct or Papilloma

CPT code 19110 denotes surgical exploration of the nipple with possible excision of a single lactiferous duct or a papilloma within a lactiferous duct. As a targeted, minor breast surgical procedure, it addresses localized benign lesions that can cause nipple discharge, pain, or other symptoms. Nationally, this code is important for coding accuracy, appropriate site-of-service designation, and aligning clinical documentation with reimbursement and quality reporting.

Key payers in typical analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find context on the clinical intent of the procedure, common sites of service, and how the code is used in practice. The publication outlines benchmarks for utilization and billing patterns, highlights documentation elements that support medical necessity, and summarizes relevant policy considerations affecting coverage and payment. Where available, readers will also see comparisons across primary payers and notes on common billing considerations.

Data not available in the input for specific associated taxonomies, ICD-10 diagnoses, and related codes.

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Billing Code Overview

CPT code 19110 describes a procedure in which the provider explores the nipple through an incision and may excise a single lactiferous duct or a papilloma of a lactiferous duct. This procedure is typically performed to evaluate and treat localized nipple pathology such as a solitary duct lesion or papilloma.

Service type: Surgical excision / exploration of a single lactiferous duct or papilloma
Typical site of service: Outpatient surgical suite, ambulatory surgical center, or hospital outpatient department

Data not available in the input for payers, associated taxonomies, and ICD-10 diagnoses.

Find policies, billing codes, payers, states, and providers

CPT 19110: Excision of Single Lactiferous Duct or Papilloma

Data not available in the input for specific associated taxonomies, ICD-10 diagnoses, and related codes.

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Get alerted when payer policies referencing 19110 are released or updated.

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Billing Code Overview

Service type: Surgical excision / exploration of a single lactiferous duct or papilloma
Typical site of service: Outpatient surgical suite, ambulatory surgical center, or hospital outpatient department

Data not available in the input for payers, associated taxonomies, and ICD-10 diagnoses.

Clinical & Coding Specifications

Clinical Context

A typical patient is a woman presenting to a breast surgery clinic with focal bloody or serous nipple discharge, a palpable subareolar mass, or imaging findings suggestive of an intraductal lesion such as a papilloma. After history, physical exam, and targeted imaging (diagnostic mammogram and ultrasound, possibly ductography or breast MRI), the surgeon discusses operative exploration of the nipple and excision of an offending lactiferous duct or papilloma. The procedure is performed in an outpatient ambulatory surgery center or hospital outpatient department under local anesthesia with sedation or general anesthesia depending on patient preference and comorbidities. The surgeon makes a periareolar or transareolar incision, identifies and selectively excises the abnormal duct or papilloma, achieves hemostasis, and closes the incision. The specimen is sent for pathology to confirm benign versus malignant disease. Typical postoperative workflow includes immediate recovery, discharge with wound care instructions, and a pathology-driven plan for follow-up; if malignancy is identified on pathology, additional staging and oncologic management are arranged.

Coding Specifications

Modifier	Description	When to Use
`25`	Significant, Separately Identifiable Evaluation and Management Service on the Same Day as Procedure	Use when a separate E/M visit is performed by the same provider on the same day as `19110` and meets documentation requirements.
`50`	Bilateral Procedure	Use if exploration and excision are performed on both breasts during the same operative session.
`51`	Multiple Procedures	Use when `19110` is billed with additional unrelated procedures during the same session (payer-specific bundling rules apply).
`52`	Reduced Services	Use when the surgeon intentionally reduces or discontinues the procedure but documents a partial service.
`53`	Discontinued Procedure	Use when the procedure is started but halted due to extenuating circumstances.
`59`	Distinct Procedural Service	Use when `19110` represents a distinct and separate procedure from other services performed at the same session.
`76`	Repeat Procedure by Same Physician	Use when the same surgeon repeats `19110` later during the postoperative period (if clinically justified).
`78`	Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period	Use if the patient returns to the OR for a complication related to the initial `19110`.
`79`	Unrelated Procedure or Service by the Same Physician During the Postoperative Period	Use when an unrelated procedure is performed during the global period.
`26`	Professional Component	Use if billing separates professional interpretation for an associated imaging or pathology service (rare for `19110` itself).
`TC`	Technical Component	Use if billing separates technical component for an associated imaging or pathology service.
`LT`	Left Side	Use to indicate procedure performed on the left breast.
`RT`	Right Side	Use to indicate procedure performed on the right breast.
`AS`	Left or Right, Side Not Specified in Global Service	Use per payer rules when laterality needs clarification.

Taxonomy Code	Specialty	Notes
`207P00000X`	General Surgery	Most common specialty performing duct excision and nipple exploration.
`207Q00000X`	Breast Surgery (Surgical Oncology)	Specialists in complex breast procedures and oncologic management.
`2086S0101X`	Plastic and Reconstructive Surgery	Performs concurrent or reconstructive procedures when cosmesis or complex closure is required.
`207RC0000X`	Colon & Rectal Surgery (example multispecialty overlap)	Not typical; include only primary specialties above.
`207L00000X`	Surgical Oncology	Often involved when malignancy is suspected or confirmed.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`N64.0`	Mastodynia	Breast pain that may prompt evaluation and possible duct exploration if associated with discharge or focal findings.
`N64.3`	Galactorrhea	Nipple discharge that may require duct evaluation and possible excision if focal or persistent.
`N64.4`	Inverted nipple	Can be associated with ductal pathology and may prompt exploration.
`N64.89`	Other specified disorders of breast	Catch-all for benign breast conditions leading to exploration of the nipple and duct.
`R31.0`	Gross hematuria (not applicable)	Data not applicable — placeholder not used clinically.
`R10.4`	Other and unspecified abdominal pain (not applicable)	Not relevant clinically for this breast-specific procedure.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`19120`	Excision, open, of breast lesion identified by preoperative placement of radiological marker, single lesion	May be performed when a nonpalpable intraductal lesion identified on imaging requires larger excision rather than limited duct excision.
`19301`	Mastectomy, partial (e.g., lumpectomy, tylectomy, quadrantectomy, segmental)	Performed if pathology from `19110` shows malignancy requiring wider excision.
`19125`	Excision of breast lesion cyst, fibroadenoma, or other benign tumor; open, one or more lesions	Alternative for palpable benign lesions larger than a single duct/papilloma or when a larger mass is removed.
`19126`	Excision of breast lesion; percutaneous, needle localization and excision	Related when image-guided localization is required for nonpalpable lesions prior to excision.
`88305`	Level IV surgical pathology, gross and microscopic examination	Performed on the excised duct or papilloma specimen for diagnostic evaluation after `19110`.
`76942`	Ultrasonic guidance for needle placement (e.g., biopsy or aspiration)	May be used preoperatively for diagnostic biopsy or localization of an intraductal lesion.

CPT 19105: Ultrasound-Guided Cryoablation of Breast Fibroadenoma

CPT-19112-EXCISION-LACTIFEROUS-DUCT-SKIN-FISTULA

CPT 19112: Excision of Lactiferous Duct–Skin Fistula

CPT-19120-OPEN-EXCISION-SUSPICIOUS-BREAST-LESION

CPT 19120: Open Excision of Suspicious Breast Lesion

CPT-19125-EXCISION-SINGLE-RADIOLOGICALLY-LOCALIZED-LESION

CPT 19125: Excision of Single Radiologically Localized Lesion

CPT-19126-ADDITIONAL-EXCISION-MARKED-BREAST-LESION

CPT 19126: Excision of Additional Marked Breast Lesion

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.

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
`25`	Significant, Separately Identifiable Evaluation and Management Service on the Same Day as Procedure	Use when a separate E/M visit is performed by the same provider on the same day as `19110` and meets documentation requirements.
`50`	Bilateral Procedure	Use if exploration and excision are performed on both breasts during the same operative session.
`51`	Multiple Procedures	Use when `19110` is billed with additional unrelated procedures during the same session (payer-specific bundling rules apply).
`52`	Reduced Services	Use when the surgeon intentionally reduces or discontinues the procedure but documents a partial service.
`53`	Discontinued Procedure	Use when the procedure is started but halted due to extenuating circumstances.
`59`	Distinct Procedural Service	Use when `19110` represents a distinct and separate procedure from other services performed at the same session.
`76`	Repeat Procedure by Same Physician	Use when the same surgeon repeats `19110` later during the postoperative period (if clinically justified).
`78`	Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period	Use if the patient returns to the OR for a complication related to the initial `19110`.
`79`	Unrelated Procedure or Service by the Same Physician During the Postoperative Period	Use when an unrelated procedure is performed during the global period.
`26`	Professional Component	Use if billing separates professional interpretation for an associated imaging or pathology service (rare for `19110` itself).
`TC`	Technical Component	Use if billing separates technical component for an associated imaging or pathology service.
`LT`	Left Side	Use to indicate procedure performed on the left breast.
`RT`	Right Side	Use to indicate procedure performed on the right breast.
`AS`	Left or Right, Side Not Specified in Global Service	Use per payer rules when laterality needs clarification.

Taxonomy Code	Specialty	Notes
`207P00000X`	General Surgery	Most common specialty performing duct excision and nipple exploration.
`207Q00000X`	Breast Surgery (Surgical Oncology)	Specialists in complex breast procedures and oncologic management.
`2086S0101X`	Plastic and Reconstructive Surgery	Performs concurrent or reconstructive procedures when cosmesis or complex closure is required.
`207RC0000X`	Colon & Rectal Surgery (example multispecialty overlap)	Not typical; include only primary specialties above.
`207L00000X`	Surgical Oncology	Often involved when malignancy is suspected or confirmed.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`N64.0`	Mastodynia	Breast pain that may prompt evaluation and possible duct exploration if associated with discharge or focal findings.
`N64.3`	Galactorrhea	Nipple discharge that may require duct evaluation and possible excision if focal or persistent.
`N64.4`	Inverted nipple	Can be associated with ductal pathology and may prompt exploration.
`N64.89`	Other specified disorders of breast	Catch-all for benign breast conditions leading to exploration of the nipple and duct.
`R31.0`	Gross hematuria (not applicable)	Data not applicable — placeholder not used clinically.
`R10.4`	Other and unspecified abdominal pain (not applicable)	Not relevant clinically for this breast-specific procedure.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`19120`	Excision, open, of breast lesion identified by preoperative placement of radiological marker, single lesion	May be performed when a nonpalpable intraductal lesion identified on imaging requires larger excision rather than limited duct excision.
`19301`	Mastectomy, partial (e.g., lumpectomy, tylectomy, quadrantectomy, segmental)	Performed if pathology from `19110` shows malignancy requiring wider excision.
`19125`	Excision of breast lesion cyst, fibroadenoma, or other benign tumor; open, one or more lesions	Alternative for palpable benign lesions larger than a single duct/papilloma or when a larger mass is removed.
`19126`	Excision of breast lesion; percutaneous, needle localization and excision	Related when image-guided localization is required for nonpalpable lesions prior to excision.
`88305`	Level IV surgical pathology, gross and microscopic examination	Performed on the excised duct or papilloma specimen for diagnostic evaluation after `19110`.
`76942`	Ultrasonic guidance for needle placement (e.g., biopsy or aspiration)	May be used preoperatively for diagnostic biopsy or localization of an intraductal lesion.

CPT 19105: Ultrasound-Guided Cryoablation of Breast Fibroadenoma

CPT-19112-EXCISION-LACTIFEROUS-DUCT-SKIN-FISTULA

CPT 19112: Excision of Lactiferous Duct–Skin Fistula

CPT-19120-OPEN-EXCISION-SUSPICIOUS-BREAST-LESION

CPT 19120: Open Excision of Suspicious Breast Lesion

CPT-19125-EXCISION-SINGLE-RADIOLOGICALLY-LOCALIZED-LESION

CPT 19125: Excision of Single Radiologically Localized Lesion

CPT-19126-ADDITIONAL-EXCISION-MARKED-BREAST-LESION

CPT 19126: Excision of Additional Marked Breast Lesion

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 19110: Excision of Single Lactiferous Duct or Papilloma

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Billing Code Overview

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CPT 19110: Excision of Single Lactiferous Duct or Papilloma

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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