Summary & Overview
CPT 19298: Image-Guided Brachytherapy Catheter Placement
CPT code 19298 denotes image-guided placement of multiple tube- and button-type brachytherapy catheters at a treatment site, commonly performed in association with breast-conserving surgery or as a separate procedure to deliver localized radiotherapy. Nationally, this code is relevant for facilities and clinicians managing postoperative or standalone brachytherapy workflows, impacting billing practices, procedural planning, and care coordination for patients requiring targeted radiation.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides a consolidated view of coverage practices and payment benchmarks for these major payers, where available, and highlights clinical context relevant to surgical and radiation oncology teams.
Readers will learn the clinical indications and settings where CPT code 19298 is applied, how it integrates with partial mastectomy care pathways, common billing considerations, and where to look for payer-specific policy language. The piece also outlines typical service lines and sites of care, and notes where input data is not available.
Billing Code Overview
CPT code 19298 describes the placement of multiple tube- and button-type brachytherapy catheters at a treatment site for radiotherapy, performed after loading brachytherapy catheters. The provider uses image guidance to ensure correct placement. This procedure may occur during the same session as a partial mastectomy or at a later date.
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Service type: Image-guided brachytherapy catheter placement for radiation treatment
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Typical site of service: Ambulatory surgical center or hospital outpatient setting; may also occur in an operating room during a partial mastectomy session
Clinical & Coding Specifications
Clinical Context
A typical patient is a woman diagnosed with early-stage breast cancer who undergoes breast-conserving surgery (partial mastectomy/lumpectomy) followed by localized high-dose-rate (HDR) brachytherapy. The procedure 19298 is performed when the radiation oncologist places multiple catheter tubes and surface button-type applicators into the lumpectomy cavity or surrounding breast tissue under image guidance (ultrasound or fluoroscopy) to facilitate subsequent fractionated radiotherapy. This may occur at the same operative session as the partial mastectomy or as a separate outpatient/interventional radiology procedure. Pre-procedure workflow includes multidisciplinary planning with the surgeon and radiation oncologist, imaging to identify the target volume, informed consent documenting risks/benefits and alternatives, anticoagulation review, and sterile preparation. During the procedure, the patient is positioned, local or general anesthesia is administered per surgeon/radiation oncologist preference, image guidance is used to confirm optimal catheter placement and depth, and catheter entry sites are secured with button-type anchors and dressings. Post-procedure workflow includes immediate imaging verification, documentation of number and type of catheters placed, pain management, discharge instructions for catheter care, scheduling of HDR brachytherapy fractions, and coordination for device removal when treatment is complete.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Unspecified | Rarely used; reserved when no specific modifier applies and payer requires a default code. |
11 | Office or other outpatient visit for evaluation and management | Use when an E/M service is billed by the same provider on the same date and the payer requires this modifier to indicate a significant, separately identifiable E/M service. |
22 | Increased procedural services | Use when work required is substantially greater than typically required for 19298, documented with justification. |
26 | Professional component | Use when reporting only the professional component of a service that has a technical and professional component. (Uncommon for 19298; included for completeness if imaging interpretation is billed separately.) |
50 | Bilateral procedure | Use when identical catheter placement is performed on both breasts during the same operative session. |
51 | Multiple procedures | Use when 19298 is performed in the same operative session with other distinct procedures; follow payer rules for multiple procedure reduction. |
52 | Reduced services | Use when the procedure is partially reduced or not completed as documented. |
53 | Discontinued procedure | Use when the procedure is started but then terminated due to extenuating circumstances or patient condition. |
62 | Two surgeons | Use when two surgeons of different specialties share operative responsibility for catheter placement. |
63 | Procedure performed on infants less than 4 kg | Not typically applicable; include only if patient meets weight criteria. |
66 | Surgical team | Use when a surgical team approach is used and payer accepts this modifier. |
73 | Discontinued outpatient hospital/ambulatory surgery center (ASC) procedure prior to anesthesia | Use if the procedure is aborted before anesthesia is administered. |
78 | Unplanned return to the operating room by the same physician following initial procedure for a related procedure during the postoperative period | Use when reoperation for catheter placement or revision occurs during global period. |
80 | Assistant surgeon | Use when an assistant surgeon is required and the payer allows billing for assistant services. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207RP0000X | Radiation Oncology | Primary specialty placing brachytherapy catheters and managing HDR treatment planning. |
| 208U00000X | Diagnostic Radiology | Image-guided catheter placement can be performed by interventional radiologists. |
| 207L00000X | Surgical Oncology | Breast surgical oncologists may place catheters at the time of partial mastectomy. |
| 208000000X | General Surgery | General surgeons who specialize in breast procedures may be involved in simultaneous placement. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
C50.911 | Malignant neoplasm of unspecified site of right female breast | Early-stage breast cancer is a common indication for lumpectomy followed by localized brachytherapy catheter placement. |
C50.912 | Malignant neoplasm of unspecified site of left female breast | Same clinical relevance for left-sided breast malignancy requiring breast-conserving therapy with brachytherapy. |
D05.10 | Lobular carcinoma in situ of right breast | May influence local therapy planning and consideration for localized radiation using catheter-based brachytherapy in selected cases. |
D05.11 | Lobular carcinoma in situ of left breast | Same as above for left breast. |
Z90.11 | Acquired absence of right breast and nipple | Relevant when reconstruction or altered anatomy affects catheter placement strategy; may influence approach. |
Z90.12 | Acquired absence of left breast and nipple | Same relevance for left-sided prior mastectomy or tissue removal. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
19301 | Partial mastectomy | Often performed immediately prior to 19298 when catheter loading is done during the same operative session. |
77790 | Remote afterloader for high dose rate (HDR) radionuclide brachytherapy, includes computed tomography (CT) localization and treatment planning (list separately in addition to brachytherapy sources) | HDR delivery code used when treatment fractions are delivered after catheter placement; relates to planning and delivery of brachytherapy through the placed catheters. |
19296 | Placement of interstitial implant (e.g., Savin, needle) for radiation therapy (separate code for different device types may exist) | Other brachytherapy catheter/implant placement codes that may be used for alternative implant techniques or device types in the same clinical context. |
77012 | Computed tomography guidance for placement of radiation therapy planning devices | Image guidance codes used when CT imaging is required to verify catheter positions for treatment planning following 19298. |
99070 | Supplies and materials (e.g., sterile trays, buttons, catheters) | Used to report billable supplies associated with catheter and button-type device placement when permitted by the payer. |