Summary & Overview
CPT 19288: MRI-Guided Add-On Breast Localization
CPT code 19288 denotes an add-on magnetic resonance image (MRI) guidance procedure used to place an additional localization device for breast lesions — for example, a clip, metallic pellet, wire/needle, or radioactive seed — when placed during the same session as an initial device. As an add-on code, it is reported in conjunction with a primary breast localization or image-guided procedure and is relevant for facilities and radiology or breast surgery providers who perform image-guided interventions.
This publication addresses national reimbursement and operational context across major payers including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of how the service is defined clinically, typical sites of service, and what to expect in claims submissions for an add-on MRI-guided localization. The report summarizes payer coverage trends, common billing modifiers observed in practice, and considerations for coding when multiple localization devices are placed in one session.
The briefing provides actionable benchmarking and policy context: it explains clinical indications for MRI-guided localization, how the add-on nature of 19288 affects reporting, typical settings where the procedure is performed, and areas where payer policies or documentation requirements commonly vary. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 19288 is an add-on magnetic resonance image (MRI) guidance procedure used to place an additional localization device for breast lesions. The procedure involves using MRI guidance to place devices such as a clip, metallic pellet, wire/needle, or radioactive seed when an additional localization is required at the same session that another device is placed at an initial lesion.
Service type: Image-guided breast localization (add-on MRI-guided localization)
Typical site of service: Outpatient imaging suite or hospital outpatient department
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult woman with a known breast lesion undergoing image-guided localization prior to surgical excision. She has multiple foci or a second lesion identified on preoperative breast magnetic resonance imaging (MRI) in the same session as an initial localization. Under MRI guidance, the breast radiologist or breast surgeon places an additional localization device (for example, a clip, metallic pellet, wire/needle, or radioactive seed) at the second lesion during the same encounter when another localization device is placed at the initial lesion. The workflow includes pre-procedure review of prior imaging and indications, informed consent, MRI localization with sterile technique in the interventional MRI suite, placement and documentation of device position with confirmatory MRI images, post-procedure site care instructions, and coordination of the localization information with the surgical team for operative planning. Typical site of service is the hospital outpatient imaging department or an ambulatory surgery center with MRI-guided interventional capability.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Normal or routine service | When the procedure represents the usual service by the primary surgeon or reporting clinician. |
22 | Increased procedural services | When substantially greater work, time, or technical difficulty is documented for MRI-guided placement of an additional localization device. |
50 | Bilateral procedure | If separate additional localization devices are placed bilaterally and payer rules permit bilateral reporting. |
52 | Reduced services | When the additional localization is partially reduced or not completed as originally planned. |
59 | Distinct procedural service | When the additional localization is distinct from other procedures performed at the same session and documentation supports separate reporting. |
62 | Two surgeons | When two surgeons work together as primary surgeons during the localization procedure. |
63 | Procedure performed on infants less than 4 kg | Uncommon for this code but used per CMS definitions if applicable. |
73 | Discontinued outpatient hospital/ambulatory surgery before anesthesia administration | If the MRI localization was attempted but discontinued before anesthesia when that circumstance applies. |
78 | Unplanned return to the operating/procedure room by the same physician following the initial procedure for a related procedure during the postoperative period | If a repeat MRI-guided localization for the same breast occurs within the global period due to a complication. |
LT | Left side | To indicate the laterality when reporting left breast localization. |
RT | Right side | To indicate the laterality when reporting right breast localization. |
XS | Separate structure or organ system | When the additional device is placed in a separate distinct lesion/site and documentation supports separate reporting distinct from the primary site. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207RH0000X | Radiology – Diagnostic | Breast radiologists commonly perform MRI-guided localizations. |
| 207RT0000X | Radiology – Therapeutic & Interventional | Interventional radiologists who perform image-guided breast procedures. |
| 208000000X | General Surgery | Breast surgeons who perform or coordinate preoperative localization and subsequent excision. |
| 207X00000X | Diagnostic Radiology | Physicians with diagnostic radiology training performing breast MRI localization. |
| 330100000X | Nuclear Medicine | When radioactive seed localization is used, nuclear medicine physicians may be involved in handling seeds. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
C50.912 | Malignant neoplasm of unspecified site of right female breast | Breast malignancy commonly requires preoperative localization of tumor foci for surgical excision; additional lesions may be localized under MRI guidance. |
C50.911 | Malignant neoplasm of unspecified site of left female breast | Left-sided breast cancer requiring localization of multiple lesions or multifocal disease. |
D05.91 | Unspecified type ductal carcinoma in situ of right breast | DCIS can be multifocal and often requires precise localization for breast-conserving surgery. |
D05.90 | Unspecified type ductal carcinoma in situ of unspecified breast | Noninvasive disease where MRI may identify additional foci needing localization. |
N63 | Unspecified lump in breast | Palpable or imaging-detected breast mass that may require localization when multiple lesions are present. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
19283 | Placement of localization device(s) for directed excision, metallic clip(s), or metallic pellet(s), including imaging guidance when performed (eg, stereotactic placement, ultrasound guidance); first lesion, each lesion | Often reported for the primary lesion localization; 19288 is an add-on when an additional device is placed in the same session under MRI guidance. |
19287 | Placement of localization device(s) for directed excision, wire/needle (eg, for breast lesion), including imaging guidance when performed; first lesion, each lesion | Used for wire localization of the initial lesion; 19288 can be used to report the additional MRI-guided device placed at the same session. |
19295 | Insertion of non-radioactive seed localization device for breast tumor, each lesion (note: example code—confirm payer policy) | Codes for seed placement when performed; 19288 describes an add-on MRI-guided additional device and may be reported in conjunction according to payer rules. |
77021 | Magnetic resonance guidance for needle placement (eg, biopsy, aspiration, injection, or localization device placement), percutaneous; each additional lesion | MRI guidance code often reported for MRI-directed procedures; used in the workflow for localization and image confirmation. |
76942 | Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation | If ultrasound guidance is used for one lesion and MRI for an additional lesion, this code may appear in the overall procedural set. |