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 |