Summary & Overview
CPT 19120: Open Excision of Breast Cyst or Tumor
Headline: CPT 19120: Open Surgical Excision for Breast Lesions — Procedure Overview and Payer Context
Lead: CPT 19120 covers open surgical excision of cysts, fibroadenomas, other benign or malignant breast tumors, aberrant breast tissue, duct lesions, and nipple or areolar lesions (excluding 19300) for one or more lesions. This code is a standard surgical billing code used across breast surgery and surgical oncology practices.
What the code represents and why it matters: CPT 19120 defines a common operative approach to remove discrete breast lesions when excision is clinically indicated. It matters nationally because it guides billing and coverage for procedures performed in operating room settings, affects surgical workflow in both hospital outpatient departments and ambulatory surgery centers, and interacts with pathology and imaging services that follow excision.
Key payers covered: This publication addresses reimbursement and policy context for Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
What readers will learn: The report provides clinical context for use of CPT 19120, comparisons to related breast procedure codes, and typical settings of care. It identifies common payer considerations and coding nuances relevant to billing and claims submission. Where input data is incomplete, the publication notes "Data not available in the input." The summary and metadata aim to support coding clarity and administrative planning for surgical breast procedures performed in outpatient operating rooms and ASCs.
CPT Code Overview
CPT 19120 describes the open surgical excision of a cyst, fibroadenoma, or other benign or malignant tumor, aberrant breast tissue, duct lesion, nipple or areolar lesion (except 19300), for male or female patients, one or more lesions. This procedure is categorized as Surgical – Breast (Surgical Oncology / General Surgery) and typically takes place in an operating room setting, either in a hospital outpatient department or an ambulatory surgery center.
Clinical & Coding Specifications
Clinical Context
A middle-aged patient presents with a palpable breast mass discovered on self-exam or clinical breast exam. Imaging (diagnostic mammography and/or targeted ultrasound) localizes a discrete lesion suspicious for a benign tumor such as a fibroadenoma, a cyst, or an indeterminate lump. After imaging assessment and possible needle biopsy, the surgical team schedules an operative excision in the operating room (hospital outpatient or ambulatory surgery center) for removal of one or more lesions under general or local anesthesia. The procedure performed is an open excision of the lesion(s) from the breast tissue for definitive diagnosis and treatment, corresponding to 19120. Typical workflow includes preoperative localization as needed, operative excision with specimen labeling and submission to pathology, intraoperative hemostasis and cosmetic closure, and postoperative recovery with discharge instructions.
Coding Specifications
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Modifiers
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59— Distinct procedural service: used when separate incisions during the same operative session are made for distinct lesions or when another procedure normally bundled with19120is performed through a separate incision, indicating a separate service. -
76— Repeat procedure by same physician: used when a subsequent incision site is treated in a later portion of the same operative session or when the same procedure is repeated by the same physician on a separate occasion; applies when documentation supports a repeat excision at a separate site.