Summary & Overview
CPT 19285: Ultrasound-Guided Breast Lesion Localization, First Lesion
CPT code 19285 covers ultrasound-guided placement of a localization device for a breast lesion — including clips, metallic pellets, wires/needles, or radioactive seeds — and applies to the first lesion treated. This procedure supports accurate localization prior to biopsy or surgical excision and is a common component of breast imaging and surgical workups. Nationally, proper coding of image-guided localization affects care coordination, procedural tracking, and payment for outpatient breast services.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for localization procedures, the typical sites of service where 19285 is reported, and the principal payers commonly involved in coverage and claims processing for these services. The publication summarizes common modifiers encountered in practice and highlights related billing considerations.
This article provides: a clear definition of the service represented by 19285; expected clinical and operational settings; payer coverage landscape; and guidance on where to look for additional policy and reimbursement details. Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes is noted where applicable.
Billing Code Overview
CPT code 19285 describes ultrasound-guided placement of a device for breast lesion localization, such as a clip, metallic pellet, wire/needle, or radioactive seeds. This code is used for the placement procedure when performed on the first lesion identified for localization.
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Service type: Image-guided breast lesion localization procedure
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Typical site of service: Outpatient imaging suite, breast clinic procedure room, or ambulatory surgery center where ultrasound guidance and minor localization devices are available.
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Clinical & Coding Specifications
Clinical Context
A 54-year-old woman with a suspicious, non-palpable breast lesion identified on diagnostic ultrasound is scheduled for ultrasound-guided localization. The patient previously underwent mammography and targeted ultrasound that demonstrated a 9-mm hypoechoic mass in the left breast. The surgeon requests placement of a localization device (clip or wire) immediately prior to a lumpectomy to assist intraoperative identification. In the outpatient breast imaging suite, a breast radiologist performs real-time ultrasound guidance to insert a localization device (such as a clip, metallic pellet, wire/needle, or radioactive seed) into the lesion. The procedure includes patient positioning, sterile preparation, local anesthesia, device placement with sonographic confirmation of position, and brief post-placement imaging and documentation. The localization is billed using 19285 for the first lesion localized. Typical workflow includes pre-procedure consent and review of images, coordination with breast surgery for operating room timing (if wire or seed), and communication of device type and laterality in the report. Typical site of service is an outpatient imaging center, hospital outpatient department, or ambulatory surgical center.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when reporting only the physician’s interpretation or performance distinct from the technical component (rare for localization but applicable if only interpretation is billed). |