Summary & Overview
CPT 19296: Balloon Catheter Placement for Breast Brachytherapy
CPT code 19296 represents image-guided placement of a single- or multichannel expandable balloon catheter at the treatment site after partial mastectomy for delivery of radiotherapy (brachytherapy). This targeted, cavity-directed approach supports breast-conserving therapy and can impact care pathways, facility utilization, and post-surgical radiation scheduling across the country. Nationally, the code is relevant to hospital outpatient departments, ambulatory surgery centers, and specialty cancer treatment centers performing breast-conserving procedures.
Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for catheter-based breast brachytherapy, payer coverage themes, and common coding considerations tied to facility and imaging resources. The publication presents benchmarks where available, highlights recent policy or coding updates impacting use of this code, and explains how service setting and image guidance contribute to coding and billing workflows. This summary is intended to orient clinicians, coding professionals, and policy analysts to the primary uses and implications of CPT code 19296 at a national level.
Data not available in the input for specific associated taxonomies, ICD-10 diagnoses, related codes, and payer-specific reimbursement rates.
Billing Code Overview
CPT code 19296 describes placement of a single- or multichannel expandable balloon catheter at the lumpectomy or partial mastectomy site for administration of radiotherapy. The procedure includes image guidance to ensure correct placement of the catheter within the surgical cavity.
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Service type: Image-guided placement of an expandable balloon catheter for brachytherapy following partial mastectomy
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Typical site of service: Outpatient surgical suite or hospital outpatient department where breast-conserving surgery and post-operative brachytherapy are performed
Clinical & Coding Specifications
Clinical Context
A typical patient is a woman who has recently undergone a partial mastectomy (lumpectomy) for early-stage invasive breast carcinoma or ductal carcinoma in situ and is scheduled for targeted adjuvant brachytherapy. Following intraoperative pathology confirmation of negative margins or a planned re-excision with margin assessment, the radiation oncology team schedules placement of a single- or multi‑channel expandable balloon catheter into the lumpectomy cavity under image guidance. The procedure is performed in an outpatient procedure suite, ambulatory surgical center, or hospital outpatient department with local anesthesia and conscious sedation or general anesthesia as clinically indicated. Under ultrasound and/or fluoroscopic guidance, the surgeon or radiation oncologist inserts the catheter into the surgical cavity, expands the balloon to conform to the cavity, and confirms position and geometry for subsequent high‑dose‑rate (HDR) or low‑dose‑rate (LDR) radiotherapy delivery. Post‑placement imaging documents catheter location and balloon inflation volume; treatment planning is completed by radiation oncology physics before the first fraction of brachytherapy. Typical clinical workflow steps: pre‑procedure consent and evaluation, image‑guided catheter placement, procedural imaging documentation, recovery and discharge instructions, and scheduled radiotherapy sessions beginning per protocol (often within days).
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Physician billing indicator (default) |