CPT 19301: Partial Mastectomy / Excision of Breast Lesion

CPT code 19301 denotes a surgical breast-conserving procedure in which a lesion, surrounding margins, or a substantial portion of the breast (segment or quadrant) is excised without complete removal of the breast or axillary lymph nodes. Nationally, this code is central to management of breast lesions that require tissue-saving approaches, balancing oncologic control with preservation of breast tissue and appearance. It is frequently used in surgical oncology and general surgery billing for lumpectomy-like procedures.

Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides a concise national perspective useful to billing managers, surgical departments, and revenue cycle staff on coding intent, clinical context, typical settings, and reimbursement relationships.

Readers will learn the clinical definition and typical site of service for CPT code 19301, the common diagnostic contexts driving use, and how this code relates to adjacent breast surgery codes. The report outlines payer coverage scope and common encounter settings, and highlights considerations for correct code selection in breast-conserving surgical procedures. Data not available in the input is noted where applicable.

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Billing Code Overview

CPT code 19301 describes the surgical removal of a lesion or a significant portion of breast tissue (such as a segment or quadrant) without removing the entire breast or axillary lymph nodes. This procedure is a partial mastectomy or breast-conserving excision focused on removing the targeted lesion and surrounding margins.

Service Type: Surgical excision of breast lesion / partial mastectomy
Typical Site of Service: Hospital operating room or ambulatory surgical center

National Reimbursement Benchmarks

Medicare average reimbursement for CPT 19301 sits at $639.8, while BUCA’s mean commercial rate is $2,100.2 — a gap of $1,460.4 that highlights a large differential between federal and average commercial payouts. This contrast reflects Medicare’s narrower locality-weighted mean versus BUCA’s substantially higher commercial positioning, with BUCA roughly 3.3 times Medicare on mean reimbursement.

Rate dispersion varies notably by payer. Blue Cross Blue Shield shows the widest interquartile spread (P75–P25 = $2,384.7), indicating substantial variability across contracts or regions, while Aetna is comparatively tight (P75–P25 = $629.6). UnitedHealth Group (spread = $720.0), Cigna (spread = $760.2), and BUCA (spread = $1,673.4) fall between those extremes. These spreads signal where commercial rate outcomes are most and least variable.

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CPT 19301: Partial Mastectomy / Excision of Breast Lesion

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Billing Code Overview

Service Type: Surgical excision of breast lesion / partial mastectomy
Typical Site of Service: Hospital operating room or ambulatory surgical center

National Reimbursement Benchmarks

National Payer Mean Reimbursement Rates

Clinical & Coding Specifications

Clinical Context

A 54-year-old female presents with a palpable breast mass and imaging consistent with a suspicious lesion. Core needle biopsy confirms invasive ductal carcinoma. The surgical team schedules a partial mastectomy (lumpectomy) to remove the primary tumor with margins while conserving the remainder of the breast. The procedure is performed in an outpatient or ambulatory surgery center under general anesthesia with intraoperative specimen orientation and margin assessment. The specimen is sent to pathology for margin status and tumor typing; sentinel lymph node biopsy or axillary sampling may be performed concurrently or in a staged fashion depending on preoperative planning and intraoperative findings. Postoperative care includes wound management, pathology review, oncology referral for adjuvant therapy planning, and routine follow-up visits for drain removal and wound checks.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the surgeon's professional service separate from facility technical components.
`50`	Bilateral procedure	Use when the partial mastectomy is performed on both breasts during the same operative session.
`51`	Multiple procedures	Use when additional distinct surgical procedures are performed during the same operative session.
`52`	Reduced services	Use when the service is partially reduced or not fully performed as described.
`53`	Discontinued procedure	Use when the operation is started but discontinued due to extenuating circumstances.
`59`	Distinct procedural service	Use to indicate a separate and distinct procedure not ordinarily reported with the primary code (e.g., a separate diagnostic procedure).
`62`	Two surgeons	Use when two surgeons with distinct, documented roles perform the procedure concurrently.
`63`	Procedure performed on infants less than 4 kg	Use only when applicable to weight-based pediatric billing (rare for this CPT).
`66`	Surgical team (concurrent surgeons)	Use when a team of surgeons with documented team operation reports provides coordinated care.
`76`	Repeat procedure by same physician	Use when the same physician repeats the procedure later the same day.
`77`	Repeat procedure by another physician	Use when a different physician repeats the procedure later the same day.
`79`	Unrelated procedure or service by the same physician during the postoperative period	Use when an unrelated procedure is performed during global period.

Taxonomy Code	Specialty	Notes
`208600000X`	Surgery Physician	General and breast surgeons who perform partial mastectomy procedures.
`207RH0003X`	Surgical Oncology Physician	Surgical oncologists specializing in cancer resections, frequently perform lumpectomy and axillary procedures.
`207N00000X`	Dermatology Physician	Dermatologic surgeons may be involved in skin-sparing approaches or resection of superficial lesions when applicable.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C50`	Malignant neoplasm of breast	Primary malignant breast tumor indicating need for oncologic breast-conserving surgery such as partial mastectomy.
`D05`	Carcinoma in situ of breast	Noninvasive breast cancer (e.g., ductal carcinoma in situ) that may be treated with partial mastectomy depending on lesion size and margins.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`19302`	Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy); with axillary lymphadenectomy	Represents a partial mastectomy when axillary lymphadenectomy is also performed during the index operation.
`38525`	Biopsy or excision of lymph node(s); open, deep axillary node(s)	Used when an open axillary lymph node biopsy or excision is performed in association with the breast excision for staging.
`19307`	Mastectomy, modified radical, including axillary lymph nodes, with or without pectoralis minor muscle, but excluding pectoralis major muscle	Represents a more extensive procedure that may be selected instead of partial mastectomy if disease extent necessitates conversion to modified radical mastectomy.

CPT 19300: Excision of Male Breast for Gynecomastia

CPT-19302-BREAST-CONSERVING-SURGERY-WITH-AXILLARY-NODE-REMOVAL

CPT 19302: Breast-Conserving Surgery with Axillary Lymph Node Removal

CPT-19303-SIMPLE-MASTECTOMY-BREAST-REMOVAL

CPT 19303: Simple Mastectomy, Removal of Breast and Nipple–Areolar Complex

CPT-19305-RADICAL-MASTECTOMY-CHEST-WALL-AND-AXILLARY-LYMPH-NODES

CPT 19305: Radical Mastectomy with Chest Wall and Axillary Lymph Node Removal

CPT-19306-RADICAL-MASTECTOMY-TOTAL-CHEST-WALL-AND-LYMPHADENECTOMY

CPT 19306: Radical Mastectomy with Chest Wall and Lymphadenectomy

CPT-19307-MASTECTOMY-REMOVAL-ENTIRE-BREAST

CPT 19307: Mastectomy, Removal of Entire Breast

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the surgeon's professional service separate from facility technical components.
`50`	Bilateral procedure	Use when the partial mastectomy is performed on both breasts during the same operative session.
`51`	Multiple procedures	Use when additional distinct surgical procedures are performed during the same operative session.
`52`	Reduced services	Use when the service is partially reduced or not fully performed as described.
`53`	Discontinued procedure	Use when the operation is started but discontinued due to extenuating circumstances.
`59`	Distinct procedural service	Use to indicate a separate and distinct procedure not ordinarily reported with the primary code (e.g., a separate diagnostic procedure).
`62`	Two surgeons	Use when two surgeons with distinct, documented roles perform the procedure concurrently.
`63`	Procedure performed on infants less than 4 kg	Use only when applicable to weight-based pediatric billing (rare for this CPT).
`66`	Surgical team (concurrent surgeons)	Use when a team of surgeons with documented team operation reports provides coordinated care.
`76`	Repeat procedure by same physician	Use when the same physician repeats the procedure later the same day.
`77`	Repeat procedure by another physician	Use when a different physician repeats the procedure later the same day.
`79`	Unrelated procedure or service by the same physician during the postoperative period	Use when an unrelated procedure is performed during global period.

Taxonomy Code	Specialty	Notes
`208600000X`	Surgery Physician	General and breast surgeons who perform partial mastectomy procedures.
`207RH0003X`	Surgical Oncology Physician	Surgical oncologists specializing in cancer resections, frequently perform lumpectomy and axillary procedures.
`207N00000X`	Dermatology Physician	Dermatologic surgeons may be involved in skin-sparing approaches or resection of superficial lesions when applicable.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C50`	Malignant neoplasm of breast	Primary malignant breast tumor indicating need for oncologic breast-conserving surgery such as partial mastectomy.
`D05`	Carcinoma in situ of breast	Noninvasive breast cancer (e.g., ductal carcinoma in situ) that may be treated with partial mastectomy depending on lesion size and margins.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`19302`	Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy); with axillary lymphadenectomy	Represents a partial mastectomy when axillary lymphadenectomy is also performed during the index operation.
`38525`	Biopsy or excision of lymph node(s); open, deep axillary node(s)	Used when an open axillary lymph node biopsy or excision is performed in association with the breast excision for staging.
`19307`	Mastectomy, modified radical, including axillary lymph nodes, with or without pectoralis minor muscle, but excluding pectoralis major muscle	Represents a more extensive procedure that may be selected instead of partial mastectomy if disease extent necessitates conversion to modified radical mastectomy.

CPT 19300: Excision of Male Breast for Gynecomastia

CPT-19302-BREAST-CONSERVING-SURGERY-WITH-AXILLARY-NODE-REMOVAL

CPT 19302: Breast-Conserving Surgery with Axillary Lymph Node Removal

CPT-19303-SIMPLE-MASTECTOMY-BREAST-REMOVAL

CPT 19303: Simple Mastectomy, Removal of Breast and Nipple–Areolar Complex

CPT-19305-RADICAL-MASTECTOMY-CHEST-WALL-AND-AXILLARY-LYMPH-NODES

CPT 19305: Radical Mastectomy with Chest Wall and Axillary Lymph Node Removal

CPT-19306-RADICAL-MASTECTOMY-TOTAL-CHEST-WALL-AND-LYMPHADENECTOMY

CPT 19306: Radical Mastectomy with Chest Wall and Lymphadenectomy

CPT-19307-MASTECTOMY-REMOVAL-ENTIRE-BREAST

CPT 19307: Mastectomy, Removal of Entire Breast

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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CPT 19301: Partial Mastectomy / Excision of Breast Lesion

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Billing Code Overview

National Reimbursement Benchmarks

OpenPayer

CPT 19301: Partial Mastectomy / Excision of Breast Lesion

Sign up for cpt 19301 policy alerts

Billing Code Overview

National Reimbursement Benchmarks

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References