Summary & Overview
CPT 19294: Tumor Cavity Preparation for IORT During Partial Mastectomy
CPT code 19294 specifies preparation of a tumor cavity for placement of a device to deliver intraoperative radiation therapy (IORT) during the same operative session as a partial mastectomy. The code captures a distinct intraoperative surgical service enabling targeted, single-fraction radiation delivered directly to the lumpectomy cavity immediately after tumor excision. Nationally, this code is relevant for surgical oncologists, radiation oncologists, and hospitals offering breast-conserving surgery with IORT capabilities.
Key payers in typical coverage discussions include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for use of the code, the typical site of service, and which payers are commonly involved in coverage decisions. The publication also outlines what to expect in benchmarking and policy review sections, including coverage policies, prior authorization patterns, reimbursement benchmarks, and clinical considerations surrounding single-session IORT in breast-conserving surgery.
The content is intended to inform billing, clinical, and administrative stakeholders about the purpose of the code, the clinical setting in which it is performed, and the payer landscape that most often accompanies claims using CPT code 19294.
Billing Code Overview
CPT code 19294 describes the intraoperative preparation of a tumor cavity for placement of a device used to deliver intraoperative radiation therapy (IORT) during the same session as a partial mastectomy. This procedure involves the surgical preparation of the lumpectomy site to accommodate an IORT applicator or device that will deliver a concentrated dose of radiation immediately after tumor excision.
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Service type: Surgical preparation for intraoperative radiation therapy device placement
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Typical site of service: Operating room or intraoperative setting during a partial mastectomy
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Clinical & Coding Specifications
Clinical Context
A 62-year-old woman with an early-stage, unifocal invasive ductal carcinoma of the breast presents for breast-conserving surgery. The surgical oncology team performs a partial mastectomy (lumpectomy) under general anesthesia. In the same operative session, the surgeon prepares the tumor cavity for placement of an intraoperative radiation therapy (IORT) device to deliver a single fraction of radiation directly to the tumor bed. The workflow includes: preoperative multidisciplinary planning with radiation oncology to confirm candidacy for IORT; intraoperative lumpectomy with margin assessment; mobilization and preparation of the lumpectomy cavity to accept the IORT applicator (device sizing, hemostasis, and packing as needed); placement and securement of the IORT device; delivery of the prescribed intraoperative radiation dose; device removal and standard wound closure; and postoperative handoff to recovery. The procedure coded by 19294 documents the surgeon’s work in preparing the tumor cavity for device placement during the same session as the partial mastectomy.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Standard reporting when no modifier applies |
22 | Increased procedural services | Use when work required is substantially greater than typical due to complexity or additional operative time |
23 | Unusual anesthesia | Use when general anesthesia or other anesthesia is medically necessary due to patient condition beyond usual local/regional anesthetic |
50 | Bilateral procedure | Use when the procedure is performed on both breasts during the same operative session |
51 | Multiple procedures | Use when 19294 is reported in addition to other distinct procedures during the same operative session (if payer requires) |
52 | Reduced services | Use when the procedure is partially performed or not completed as planned |
53 | Discontinued procedure | Use when the procedure is terminated due to patient-related or intraoperative circumstances before completion |
62 | Two surgeons | Use when two surgeons work together as primary surgeons performing distinct portions of the operation |
78 | Unplanned return to OR | Use when a return to the operating room for a related procedure occurs within the global period |
80 | Assistant surgeon | Use when an assistant surgeon is documented and appropriate to report assistance |
81 | Minimum assistant surgeon | Use when minimal assistance is provided and reported per payer policy |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant-at-surgery | Use when an advanced practice clinician is documented as the assistant at surgery and allowed by payer |
LT | Left side | Use when procedure performed on the left breast (when laterality is required) |
RT | Right side | Use when procedure performed on the right breast (when laterality is required) |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
2085P0200X | Surgical Oncology | Primary surgeons who perform breast-conserving surgery and IORT cavity preparation |
207Q00000X | General Surgery | General surgeons with breast specialization who may perform partial mastectomy and prepare the cavity |
2084P0800X | Radiation Oncology | Radiation oncologists involved in intraoperative radiation therapy planning and device use; may be present intraoperatively |
363L00000X | Nurse Practitioner | Advanced practice clinicians who may assist intraoperatively or serve as surgical assistants depending on state law |
363A00000X | Physician Assistant | PAs who assist in surgery and may be reported with appropriate assistant modifiers |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
C50.911 | Malignant neoplasm of unspecified site of right female breast | Represents invasive breast cancer of the right breast eligible for partial mastectomy with IORT when anatomically appropriate |
C50.912 | Malignant neoplasm of unspecified site of left female breast | Represents invasive breast cancer of the left breast eligible for breast-conserving surgery with IORT when appropriate |
D05.10 | Lobular carcinoma in situ of the breast, unspecified site | High-risk in-situ lesion sometimes managed with breast-conserving approaches; may be part of surgical planning for lumpectomy and IORT in selected contexts |
D05.11 | Lobular carcinoma in situ of right breast | Site-specific in-situ diagnosis relevant when planning unilateral breast-conserving surgery and IORT |
D05.12 | Lobular carcinoma in situ of left breast | Site-specific in-situ diagnosis relevant when planning unilateral breast-conserving surgery and IORT |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
19301 | Partial mastectomy (lumpectomy), with or without axillary sampling | The primary breast-conserving surgical procedure performed in the same session; 19294 is reported when preparing the tumor cavity for IORT during this operation |
77263 | Special medical radiation physics consultation, review and interpretation prior to complex radiation therapy | Preoperative or intraoperative radiation physics planning and consultation associated with IORT device commissioning and dose planning |
77520 | Insertion or repositioning of radiation source (brachytherapy), interstitial | Related to device placement and radiation delivery techniques; performed by radiation oncology team when intraoperative radiation sources are placed or managed |
77499 | Unlisted radiation therapy procedure | Used when a specific IORT delivery or device-related procedure lacks an exact CPT descriptor and an unlisted radiation code is required for billing |
99024 | Postoperative follow-up visit, related to routine postoperative care during postoperative period | Global period postoperative visits after the partial mastectomy and IORT session for routine follow-up and wound assessment |