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.
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.
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Service Type: Surgical excision of breast lesion / partial mastectomy
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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. |
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. |