Summary & Overview
CPT 19281: Breast Lesion Localization Under Mammographic Guidance
CPT code 19281 designates image-guided placement of a localization device in the breast under mammographic guidance for the first lesion. This code captures a routine preoperative or diagnostic step that facilitates accurate surgical excision or targeted biopsy and is widely used in breast imaging and surgical workflows. Nationally, proper coding of localization procedures affects facility and professional billing, resource planning in radiology departments, and consistency in quality measurement for breast care pathways. Key payers considered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will gain a concise understanding of what CPT code 19281 represents clinically and operationally, where the service is typically performed, and which major payers are relevant for coverage and claims processing. The publication provides benchmarks for utilization patterns, notes common billing modifiers and payer-specific coding considerations, and summarizes clinical context linking localization to biopsy and surgical planning. Data not available in the input is identified where applicable, and the focus remains national policy and billing implications rather than state-level details.
Billing Code Overview
CPT code 19281 describes placement of a device for breast lesion localization under mammographic guidance. The procedure includes placement of a clip, metallic pellet, wire, needle, or radioactive seeds used to mark a target lesion for subsequent diagnostic or therapeutic procedures. Use of CPT code 19281 is intended for the first lesion localized during the imaging-guided session.
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Service type: Image-guided breast lesion localization
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Typical site of service: Breast imaging suite, radiology department, or an outpatient ambulatory care setting where mammographic guidance is available
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Clinical & Coding Specifications
Clinical Context
A 58-year-old woman with a screening mammogram that identified a 9 mm suspicious spiculated mass in the right breast is scheduled for marker placement under mammographic guidance prior to surgical excision. The patient arrives to the breast imaging suite on the day of localization. The radiology team reviews prior imaging and consent, confirms the target lesion on real-time mammographic views (stereotactic or tomosynthesis guidance), administers local anesthesia, and places a localization device (e.g., clip, metallic pellet, or wire/seed) into the lesion. Post-placement mammographic images document device position relative to the lesion. The patient is discharged to the surgical team for targeted resection later the same day or within days as planned. Typical site of service is an outpatient hospital radiology department or an ambulatory imaging center dedicated to breast procedures.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing only the physician interpretation or placement component separate from technical facility charges |
TC | Technical component | When billing only the facility/equipment/component without the physician work |