Summary & Overview
CPT 19297: Balloon Catheter Placement During Partial Mastectomy, Image-Guided
CPT code 19297 denotes an add-on intraoperative procedure: placement of a single- or multichannel expandable balloon catheter for radiotherapy at the same session as a partial mastectomy, performed with image guidance. This code matters nationally because it captures a distinct, device-based step in breast-conserving surgery that supports delivery of targeted post-lumpectomy radiation, affecting billing, hospital workflow, and device utilization.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for catheter-based brachytherapy delivery at the time of partial mastectomy, the service setting typically involved (hospital OR or ambulatory surgical center), and common billing considerations tied to add-on procedure reporting. The publication summarizes benchmarks and coverage patterns where available and highlights policy and coding factors that influence claims submission and reimbursement pathways for this device-placement add-on. Data not available in the input is noted where coverage details, associated taxonomies, and ICD-10 mappings would normally appear.
Billing Code Overview
CPT code 19297 describes an add-on procedure in which the provider inserts a single- or multichannel expandable balloon catheter for radiotherapy at the same session as a partial mastectomy. The procedure is performed with image guidance to ensure correct placement of the catheter.
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Service type: Intraoperative catheter insertion for adjuvant radiotherapy (balloon catheter placement during partial mastectomy)
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Typical site of service: Hospital operating room or ambulatory surgical center during the partial mastectomy session
Clinical & Coding Specifications
Clinical Context
A 62-year-old female with a 1.5 cm, early-stage, invasive ductal carcinoma of the right breast undergoes breast-conserving surgery (partial mastectomy/lumpectomy) under general anesthesia. At the same operative session, the surgeon places a single- or multi-channeled expandable balloon catheter into the lumpectomy cavity for subsequent targeted radiotherapy (brachytherapy). Image guidance (intraoperative ultrasound and fluoroscopy) is used to confirm correct catheter position and balloon expansion. The catheter remains in place to allow a course of high-dose-rate or low-dose-rate radiotherapy per the radiation oncologist’s protocol; the device may be removed after completion of the prescribed treatments or left for a short interval if scheduled external beam boost is planned. Typical workflow steps: preoperative planning with breast imaging and multidisciplinary discussion; informed consent addressing concurrent device placement for brachytherapy; partial mastectomy with margin assessment; intraoperative insertion and imaging confirmation of the expandable balloon catheter (this add-on procedure); documentation of catheter type, channel configuration, imaging used, and any immediate complications; coordination with radiation oncology for post-operative treatment planning and delivery.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when reporting only the physician’s interpretation or professional component of imaging guidance if billed separately from facility services. |