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CPT 19125: Excision of Single Radiologically Localized Lesion

CPT code 19125 denotes the open surgical excision of a single lesion previously localized by a preoperative radiological marker. The code is used for targeted removal of lesions identified on imaging and matters nationally because it captures a common breast- and soft-tissue–preserving procedure often used in diagnostic and therapeutic workflows. Proper coding affects claim adjudication, care-site classification, and clinical episode attribution.

Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical intent and site-of-service considerations, common ICD-10 diagnostic contexts linked to this procedure, and how this code relates to adjacent surgical codes such as 19301 (partial mastectomy/lumpectomy). The publication also outlines commonly reported modifiers and the typical specialties that bill for the service, supporting operational coding accuracy and payer contract alignment.

This summary is intended for coding professionals, surgical practices, and revenue cycle teams seeking a national-level reference on clinical application and billing context for CPT code 19125.

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Billing Code Overview

CPT code 19125 describes the surgical excision of a single lesion that was previously localized with a preoperative radiological marker and removed through an open incision. This procedure typically involves a targeted, image-guided approach to identify and excise an identified lesion.

Service type: Open surgical excision of a radiologically localized lesion
Typical site of service: Ambulatory surgical center or hospital operating room

National Reimbursement Benchmarks

Nationally, Medicare’s mean rate of $650.30 sits below the BUCA average commercial mean of $1,874.50, indicating that commercial negotiated rates for CPT 19125 are substantially higher than the federal program’s typical reimbursement. The gap of $1,224.20 between BUCA and Medicare highlights a material difference in payer mix for this code.

Examining dispersion using the interquartile range (P75 minus P25), Blue Cross Blue Shield shows the widest spread at $2,940.40 (P75 $3,817.40 minus P25 $987.60), followed by UnitedHealth Group with a spread of $555.20 and Cigna with $500.40. Aetna has a tighter IQR of $369.20, while BUCA’s IQR is $1,795.70 and Medicare’s IQR is $65.00, making Medicare the tightest and Blue Cross Blue Shield the widest in rate dispersion.

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CPT 19125: Excision of Single Radiologically Localized Lesion

This summary is intended for coding professionals, surgical practices, and revenue cycle teams seeking a national-level reference on clinical application and billing context for CPT code 19125.

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Billing Code Overview

Service type: Open surgical excision of a radiologically localized lesion
Typical site of service: Ambulatory surgical center or hospital operating room

National Reimbursement Benchmarks

National Payer Mean Reimbursement Rates

Clinical & Coding Specifications

Clinical Context

A typical patient is a woman who presents with a palpable breast mass or an abnormality seen on screening mammography or breast MRI. Imaging identifies a single lesion marked preoperatively with a radiologic localization device (wire localization, radioactive seed, or magnetic marker). The patient is scheduled for an outpatient open surgical excision of that single radiologically marked lesion under general or local with sedation. The workflow includes preoperative imaging review and localization, informed consent, operating room or procedure suite preparation, intraoperative correlation of the specimen with the radiologic marker and specimen radiograph when indicated, pathologic specimen submission for frozen section or permanent histology, and postoperative wound care instructions. Typical sites of service are an ambulatory surgery center or hospital outpatient department. Common clinical scenarios include excision of a benign fibroadenoma (D24.1/D24.2), removal of an indeterminate mass for diagnostic purposes (N63), or excision of a previously localized suspicious lesion for definitive diagnosis or treatment in the setting of known or suspected breast cancer (C50.911/C50.912).

Coding Specifications

Modifier	Description	When to Use
`25`	Significant, separately identifiable E/M service by the same physician on the same day	Use when a distinct evaluation and management visit is performed on the same day as the excision (pre- or postoperative visit documented separately).
`26`	Professional component	Use when billing only the physician's professional component for an associated diagnostic service (e.g., interpretation of specimen imaging) separate from technical component billing.
`50`	Bilateral procedure	Use when the same CPT service is performed on both breasts during the same operative session and payer accepts bilateral modifier for this code.
`51`	Multiple procedures	Use when additional distinct procedures are performed during the same session; supports appropriate multiple-procedure payment adjustments.
`52`	Reduced services	Use when the excision is partially reduced or not fully completed as documented (e.g., aborted for patient safety).
`53`	Discontinued procedure	Use when the procedure is started but discontinued for reasons such as intraoperative complication.
`59`	Distinct procedural service	Use to indicate a distinct procedure or service not normally reported together; appropriate when another unrelated procedure is performed same day at a separate site.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons performing distinct portions of the same operative procedure.
`63`	Procedure performed on infants less than 4 kg	Not commonly used for breast excisions but included when applicable in neonatal patients.
`76` (represented in list as not present)	Data not listed in input.	Data not available in the input.

Taxonomy Code	Specialty	Notes
`207NS0135X`	Surgical Oncology	Frequently performs breast-conserving excisions for malignant or suspicious lesions.
`207RG0100X`	Gastroenterology	May be listed in input but is not a typical primary provider for this breast procedure; included per input.
`207RG0300X`	Vascular Surgery	Included per input; not typically primary for breast lesion excision.
`207RH0003X`	Hospice and Palliative Medicine	May be involved in advanced cancer care contexts; not a primary surgeon for excision.
`207RS0010X`	Surgery of the Hand	Listed in input; not a typical breast surgeon specialty but included per provided taxonomies.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`N63`	Unspecified lump in breast	Common indication for diagnostic excision of a palpable or image-detected lesion when characterization is needed.
`D24.1`	Benign neoplasm of right breast	Represents a benign lesion (eg, fibroadenoma) that may be excised for symptoms or diagnostic confirmation.
`D24.2`	Benign neoplasm of left breast	As above, for lesions of the left breast.
`C50.911`	Malignant neoplasm of unspecified site of right female breast	Indicates a confirmed or suspected right-sided breast cancer; targeted excision of a localized marked lesion may be part of diagnosis or breast-conserving therapy.
`C50.912`	Malignant neoplasm of unspecified site of left female breast	Indicates confirmed or suspected left-sided breast cancer; relevant when the marked lesion is oncologic.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`19301`	Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy)	Represents a larger breast-conserving resection; may be billed when the excision is a formal partial mastectomy rather than removal of a single radiologically localized lesion.

CPT 19105: Ultrasound-Guided Cryoablation of Breast Fibroadenoma

CPT-19110-EXCISION-SINGLE-LACTIFEROUS-DUCT-PAPILLOMA

CPT 19110: Excision of Single Lactiferous Duct or Papilloma

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-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.

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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 E/M service by the same physician on the same day	Use when a distinct evaluation and management visit is performed on the same day as the excision (pre- or postoperative visit documented separately).
`26`	Professional component	Use when billing only the physician's professional component for an associated diagnostic service (e.g., interpretation of specimen imaging) separate from technical component billing.
`50`	Bilateral procedure	Use when the same CPT service is performed on both breasts during the same operative session and payer accepts bilateral modifier for this code.
`51`	Multiple procedures	Use when additional distinct procedures are performed during the same session; supports appropriate multiple-procedure payment adjustments.
`52`	Reduced services	Use when the excision is partially reduced or not fully completed as documented (e.g., aborted for patient safety).
`53`	Discontinued procedure	Use when the procedure is started but discontinued for reasons such as intraoperative complication.
`59`	Distinct procedural service	Use to indicate a distinct procedure or service not normally reported together; appropriate when another unrelated procedure is performed same day at a separate site.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons performing distinct portions of the same operative procedure.
`63`	Procedure performed on infants less than 4 kg	Not commonly used for breast excisions but included when applicable in neonatal patients.
`76` (represented in list as not present)	Data not listed in input.	Data not available in the input.

Taxonomy Code	Specialty	Notes
`207NS0135X`	Surgical Oncology	Frequently performs breast-conserving excisions for malignant or suspicious lesions.
`207RG0100X`	Gastroenterology	May be listed in input but is not a typical primary provider for this breast procedure; included per input.
`207RG0300X`	Vascular Surgery	Included per input; not typically primary for breast lesion excision.
`207RH0003X`	Hospice and Palliative Medicine	May be involved in advanced cancer care contexts; not a primary surgeon for excision.
`207RS0010X`	Surgery of the Hand	Listed in input; not a typical breast surgeon specialty but included per provided taxonomies.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`N63`	Unspecified lump in breast	Common indication for diagnostic excision of a palpable or image-detected lesion when characterization is needed.
`D24.1`	Benign neoplasm of right breast	Represents a benign lesion (eg, fibroadenoma) that may be excised for symptoms or diagnostic confirmation.
`D24.2`	Benign neoplasm of left breast	As above, for lesions of the left breast.
`C50.911`	Malignant neoplasm of unspecified site of right female breast	Indicates a confirmed or suspected right-sided breast cancer; targeted excision of a localized marked lesion may be part of diagnosis or breast-conserving therapy.
`C50.912`	Malignant neoplasm of unspecified site of left female breast	Indicates confirmed or suspected left-sided breast cancer; relevant when the marked lesion is oncologic.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`19301`	Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy)	Represents a larger breast-conserving resection; may be billed when the excision is a formal partial mastectomy rather than removal of a single radiologically localized lesion.

CPT 19105: Ultrasound-Guided Cryoablation of Breast Fibroadenoma

CPT-19110-EXCISION-SINGLE-LACTIFEROUS-DUCT-PAPILLOMA

CPT 19110: Excision of Single Lactiferous Duct or Papilloma

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-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.

OpenPayer

CPT 19125: Excision of Single Radiologically Localized Lesion

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Billing Code Overview

National Reimbursement Benchmarks

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CPT 19125: Excision of Single Radiologically Localized Lesion

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Billing Code Overview

National Reimbursement Benchmarks

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