CPT 19301: Partial Mastectomy / Lumpectomy (Breast-Conserving Surgery)

Medicare pays $640 and commercial payers pay $2100 on average nationally for this procedure.

CPT code 19301 describes removal of a breast lesion with surrounding margins or excision of a segment or quadrant of the breast without removal of the entire breast or lymph nodes; this represents a partial mastectomy / lumpectomy (breast-conserving surgery) procedure typically performed in an operating room or ambulatory surgical center as a surgical oncology/breast surgery service for treatment of localized breast lesions.

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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 / Lumpectomy (Breast-Conserving Surgery)

Medicare pays $640 and commercial payers pay $2100 on average nationally for this procedure.

Customize your policy alerts

Sign up for cpt 19301 policy alerts

Get alerted when payer policies referencing 19301 are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

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.

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.

Related Modifiers

12 rows

Modifier	Description	When to Use
26	Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…	- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
50	Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…	- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
51	Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…	- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
53	Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…	- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
59	Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…	- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
62	Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…	- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
63	Modifier‑63 is appended to surgical CPT codes (20000–69990) when a procedure is performed on a neonate or infant weighing ≤ 4 kg (about 8.8 lbs). The AMA/AAPC definition specifies this use and notes…	- Use modifier -63 only for surgical procedures in the CPT 20000–69990 series performed on a neonate or infant who weighs ≤ 4 kg at the time of the procedure; it indicates increased complexity due to…
66	Modifier 66 (Surgical Team) is used when three or more surgeons act as primary surgeons on a single, highly complex procedure. The AMA defines it for use when a surgical team — often composed of…	- Use modifier 66 when three or more surgeons act as primary surgeons working collaboratively as a surgical team on a single, highly complex or difficult procedure (for example organ…
76	Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…	- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…

Showing 1–10 of 12

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
208600000X	Surgery Physician	A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of s…
207RH0003X	Hematology & Oncology Physician	An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy t…
207N00000X	Dermatology Physician	A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genital…
207RA0201X	Allergy & Immunology (Internal Medicine) Physician	An internist doctor of osteopathy that specializes in the treatment of allergy and immunologic disorders. A doctor of osteopathy that is board eligib…
3336M0003X	Managed Care Organization Pharmacy	A pharmacy owned by a managed care organization (MCO) used by pharmacists for the compounding and dispensing of medicinal preparations to that MCO's c…
261QM2800X	Methadone Clinic	An entity, facility, or distinct part of a facility providing diagnostic, and replacement maintenance treatment services related to individuals with d…
133VN1005X	Renal Nutrition Registered Dietitian	An individual who is a Board Certified Specialist in Renal Nutrition and works directly with adult and/or pediatric patients with acute kidney injury,…
261QD1600X	Developmental Disabilities Clinic/Center	An entity, facility, or distinct part of a facility providing comprehensive, multidiscipline diagnostic, treatment, therapy, training, and counseling …

Related ICD-10-CM Codes

28 rows

ICD-10-CM Code	Description
C50
C50.111	Malignant neoplasm of central portion of right female breast
C50.112	Malignant neoplasm of central portion of left female breast
C50.121	Malignant neoplasm of central portion of right male breast
C50.122	Malignant neoplasm of central portion of left male breast
C50.211	Malignant neoplasm of upper-inner quadrant of right female breast
C50.212	Malignant neoplasm of upper-inner quadrant of left female breast
C50.311	Malignant neoplasm of lower-inner quadrant of right female breast
C50.312	Malignant neoplasm of lower-inner quadrant of left female breast
C50.411	Malignant neoplasm of upper-outer quadrant of right female breast

Showing 1–10 of 28

Related Payer Policy Updates

Specialty: General Surgery1 / 3

10 rows

Policy	Payer	Effective Date
Site of Service Ambulatory Service Center (ASC) Select — Surgical or Diagnostic Procedures in Adults	Premera Bluecross	2026-09-01
Site of Service Ambulatory Surgical Center (ASC) Select — Surgical or Diagnostic Procedures in Adults	Premera Bluecross	2026-09-01
Site of Service Ambulatory Service Center (ASC) Select	Premera Bluecross	2026-09-01
Site of Service Ambulatory Surgical Center (ASC) Select — Site of Service for Ambulatory Surgical Procedures (ASC Select)	Premera Bluecross	2026-09-01
Site of Service Ambulatory Service Center (ASC) Select	Premera Bluecross	2026-09-01
Outpatient Surgical Procedures - Site of Service	sierra health and life	2026-08-01
Medical Necessity Guidelines — Inpatient Surgical Care	Mass General Brigham Health Plan	2026-08-01
Ambulatory Surgery Center (ASC) - Site of Care Policy	Kaiser Permanente	2026-08-01
Inpatient Surgical Site of Service	Providence Health Plan	2026-07-01
Removal of Implantable Devices	Blue Cross Blue Shield - Rhode Island	2026-07-01

CPT 19300: Excision of Male Gynecomastia

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

CPT 19302: Partial Mastectomy with Axillary Lymph Node Removal

CPT-19303-SIMPLE-MASTECTOMY-BREAST-REMOVAL

CPT 19303: Simple (Total) Mastectomy

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

CPT 19305: Radical Mastectomy with Axillary Lymph Node Removal

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

CPT 19306: Radical Mastectomy with Chest Muscle and Lymph Node Removal

CPT-19307-MASTECTOMY-REMOVAL-ENTIRE-BREAST

CPT 19307: Mastectomy, Complete Removal of Breast

Frequently Asked Questions

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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Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

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Clinical & Coding Specifications

Clinical Context

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.

Related Modifiers

12 rows

Modifier	Description	When to Use
26	Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…	- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
50	Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…	- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
51	Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…	- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
53	Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…	- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
59	Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…	- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
62	Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…	- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
63	Modifier‑63 is appended to surgical CPT codes (20000–69990) when a procedure is performed on a neonate or infant weighing ≤ 4 kg (about 8.8 lbs). The AMA/AAPC definition specifies this use and notes…	- Use modifier -63 only for surgical procedures in the CPT 20000–69990 series performed on a neonate or infant who weighs ≤ 4 kg at the time of the procedure; it indicates increased complexity due to…
66	Modifier 66 (Surgical Team) is used when three or more surgeons act as primary surgeons on a single, highly complex procedure. The AMA defines it for use when a surgical team — often composed of…	- Use modifier 66 when three or more surgeons act as primary surgeons working collaboratively as a surgical team on a single, highly complex or difficult procedure (for example organ…
76	Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…	- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…

Showing 1–10 of 12

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
208600000X	Surgery Physician	A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of s…
207RH0003X	Hematology & Oncology Physician	An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy t…
207N00000X	Dermatology Physician	A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genital…
207RA0201X	Allergy & Immunology (Internal Medicine) Physician	An internist doctor of osteopathy that specializes in the treatment of allergy and immunologic disorders. A doctor of osteopathy that is board eligib…
3336M0003X	Managed Care Organization Pharmacy	A pharmacy owned by a managed care organization (MCO) used by pharmacists for the compounding and dispensing of medicinal preparations to that MCO's c…
261QM2800X	Methadone Clinic	An entity, facility, or distinct part of a facility providing diagnostic, and replacement maintenance treatment services related to individuals with d…
133VN1005X	Renal Nutrition Registered Dietitian	An individual who is a Board Certified Specialist in Renal Nutrition and works directly with adult and/or pediatric patients with acute kidney injury,…
261QD1600X	Developmental Disabilities Clinic/Center	An entity, facility, or distinct part of a facility providing comprehensive, multidiscipline diagnostic, treatment, therapy, training, and counseling …

Related ICD-10-CM Codes

28 rows

ICD-10-CM Code	Description
C50
C50.111	Malignant neoplasm of central portion of right female breast
C50.112	Malignant neoplasm of central portion of left female breast
C50.121	Malignant neoplasm of central portion of right male breast
C50.122	Malignant neoplasm of central portion of left male breast
C50.211	Malignant neoplasm of upper-inner quadrant of right female breast
C50.212	Malignant neoplasm of upper-inner quadrant of left female breast
C50.311	Malignant neoplasm of lower-inner quadrant of right female breast
C50.312	Malignant neoplasm of lower-inner quadrant of left female breast
C50.411	Malignant neoplasm of upper-outer quadrant of right female breast

Showing 1–10 of 28

Related Payer Policy Updates

Specialty: General Surgery1 / 3

10 rows

Policy	Payer	Effective Date
Site of Service Ambulatory Service Center (ASC) Select — Surgical or Diagnostic Procedures in Adults	Premera Bluecross	2026-09-01
Site of Service Ambulatory Surgical Center (ASC) Select — Surgical or Diagnostic Procedures in Adults	Premera Bluecross	2026-09-01
Site of Service Ambulatory Service Center (ASC) Select	Premera Bluecross	2026-09-01
Site of Service Ambulatory Surgical Center (ASC) Select — Site of Service for Ambulatory Surgical Procedures (ASC Select)	Premera Bluecross	2026-09-01
Site of Service Ambulatory Service Center (ASC) Select	Premera Bluecross	2026-09-01
Outpatient Surgical Procedures - Site of Service	sierra health and life	2026-08-01
Medical Necessity Guidelines — Inpatient Surgical Care	Mass General Brigham Health Plan	2026-08-01
Ambulatory Surgery Center (ASC) - Site of Care Policy	Kaiser Permanente	2026-08-01
Inpatient Surgical Site of Service	Providence Health Plan	2026-07-01
Removal of Implantable Devices	Blue Cross Blue Shield - Rhode Island	2026-07-01

CPT 19300: Excision of Male Gynecomastia

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

CPT 19302: Partial Mastectomy with Axillary Lymph Node Removal

CPT-19303-SIMPLE-MASTECTOMY-BREAST-REMOVAL

CPT 19303: Simple (Total) Mastectomy

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

CPT 19305: Radical Mastectomy with Axillary Lymph Node Removal

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

CPT 19306: Radical Mastectomy with Chest Muscle and Lymph Node Removal

CPT-19307-MASTECTOMY-REMOVAL-ENTIRE-BREAST

CPT 19307: Mastectomy, Complete Removal of Breast

Frequently Asked Questions

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.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

OpenPayer

CPT 19301: Partial Mastectomy / Lumpectomy (Breast-Conserving Surgery)

Sign up for cpt 19301 policy alerts

National Reimbursement Benchmarks

OpenPayer

CPT 19301: Partial Mastectomy / Lumpectomy (Breast-Conserving Surgery)

Sign up for cpt 19301 policy alerts

National Reimbursement Benchmarks

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Payer Policy Updates

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Payer Policy Updates

Related Codes

References

CPT 19301: Partial Mastectomy / Lumpectomy (Breast-Conserving Surgery)

Sign up for cpt 19301 policy alerts

National Reimbursement Benchmarks

CPT 19301: Partial Mastectomy / Lumpectomy (Breast-Conserving Surgery)

Sign up for cpt 19301 policy alerts

National Reimbursement Benchmarks

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Payer Policy Updates

Related Codes

What procedure does CPT 19301 represent?

How do related CPT codes 19302, 38525, and 19307 relate to 19301?

In what clinical situations is CPT 19301 used?

Which payers are listed for CPT 19301 and does the page provide reimbursement rates?

What postoperative care and perioperative setting are described for CPT 19301?

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Payer Policy Updates

Related Codes

What procedure does CPT 19301 represent?

How do related CPT codes 19302, 38525, and 19307 relate to 19301?

In what clinical situations is CPT 19301 used?

Which payers are listed for CPT 19301 and does the page provide reimbursement rates?

What postoperative care and perioperative setting are described for CPT 19301?

References