CPT 19301: Partial Mastectomy / Excision of Breast Lesion - OpenPayer

Summary & Overview

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.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 19301breast surgerypartial mastectomysurgical oncologylumpectomyoperative codingbreast lesion excisionambulatory surgeryhospital outpatient

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

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.

CPT 11620: Excision of Malignant Skin Lesion ≤0.5 cm, Scalp/Neck/Hands/Feet/Genitalia

cpt-14001-adjacent-tissue-transfer-trunk-10-1-to-30cm2

CPT 14001: Adjacent Tissue Transfer for Trunk Defect 10.1–30.0 cm2

12002

CPT 12002: Simple Repair of Superficial Wounds, 2.6–7.5 cm

cpt-12005-simple-repair-superficial-wound-12-6-to-20cm

CPT 12005: Simple Repair of Superficial Wound 12.6–20.0 cm

cpt-11042-surgical-debridement-skin-subcutaneous

CPT 11042: Surgical Debridement of Skin and Subcutaneous Tissue, up to 20 cm2

12005

CPT 12005: Simple Repair of Superficial Wounds, 12.6–20.0 cm

cpt-15202-soft-tissue-reconstruction-skin-graft

CPT 15202: Soft Tissue Reconstruction, Skin Graft or Tissue Transfer

cpt-11602-excision-malignant-lesion-trunk-arms-legs-1-1-2-0cm

CPT 11602: Excision of Malignant Skin Lesion, 1.1–2.0 cm, Trunk/Arms/Legs

15738

CPT 15738: Muscle or Fasciocutaneous Flap for Lower Extremity

cpt-11044-bone-debridement-20cm2-or-less

CPT 11044: Surgical Debridement Involving Bone, ≤20 cm2

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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.

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