Summary & Overview
CPT 19302: Breast-Conserving Surgery with Axillary Lymph Node Removal
CPT code 19302 represents a breast-conserving surgical procedure in which a lesion or a substantial portion of the breast (segment or quadrant) is excised along with axillary lymph node removal. This code is central to surgical management of breast malignancy and high-risk breast lesions because it combines tumor excision with regional nodal assessment or clearance, affecting staging, adjuvant therapy decisions, and quality measures.
Key national payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find benchmarking context on utilization patterns and reimbursement considerations, clinical context linking the procedure to oncologic care pathways, and coding relationships to related breast and axillary procedures. The publication outlines typical sites of service and the clinical rationale for combining breast-conserving surgery with axillary node procedures.
This summary provides a national perspective for clinicians, coding professionals, and policy analysts on how CPT code 19302 is used in practice, where it fits among related mastectomy and lymph node procedure codes, and what operational elements—such as site of service and clinical indications—are commonly associated with claims using this code.
Billing Code Overview
CPT code 19302 describes the surgical removal of a breast lesion, including surrounding margins, or removal of a significant portion of the breast (such as a segment or quadrant), performed together with removal of axillary lymph nodes. This procedure is a breast-conserving surgery with axillary lymph node removal intended to treat malignant or high-risk lesions while addressing regional nodal disease.
Service type: Surgical, oncologic breast procedure
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 mass in the upper outer quadrant of the right breast and a core needle biopsy confirming invasive ductal carcinoma. Imaging shows a localized lesion without distant metastasis. The surgical plan is a partial mastectomy (segmental resection/quadrantectomy) with removal of regional axillary lymph nodes for staging and local control. Preoperative workflow includes history and physical, imaging review (mammography/ultrasound, possible MRI), biopsy pathology, pre-op clearance, and sentinel lymph node mapping in the operating room. Intraoperatively, the surgeon performs a resection of the lesion with surrounding margins (segment or quadrant) and performs sentinel lymph node biopsy or targeted axillary node excision; specimens are sent for pathology and, if needed, frozen section. Postoperative workflow includes recovery, pathology review for margin status and nodal involvement, coordination with Medical Oncology and Radiation Oncology for adjuvant therapy decisions, and documentation of laterality and any modifiers (for example LT/RT for laterality or 22 for increased procedural service) in the operative note and claim submission.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT | Left side | Use to indicate the procedure was performed on the left breast. |
RT | Right side | Use to indicate the procedure was performed on the right breast. |
22 | Increased procedural services | Use when the operative report documents substantially greater work than typical for a partial mastectomy with axillary node removal (requires supporting documentation). |
59 | Distinct procedural service | Use when a separate, distinct procedure is performed at the same operative session that is not typically bundled. |
26 | Professional component | Use when billing separates the physician (professional) component from the technical component of a service. |
52 | Reduced services | Use when the service was partially reduced or not completed as described by the full CPT code. |
53 | Discontinued procedure | Use when the procedure was started but terminated for clinical reasons prior to completion. |
62 | Two surgeons | Use when two surgeons from different specialties work together as primary surgeons. |
80 | Assistant surgeon | Use when an assistant surgeon is involved and paid separately. |
51 | Multiple procedures | Use when multiple additional procedures are billed during the same operative session. |
QY | Service furnished in part by a PA | Use when a physician assistant performs portions of the service under physician direction and billing requires this identification. |
QX | Service performed by assistant qualified under NPP rules | Use when an assistant at surgery meets state/supervision requirements and is billed accordingly. |
QK | Anesthesia-directed CRNA | Use when a CRNA provides anesthesia under an anesthesiologist-directed model (as applicable to facility billing alignment). |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist in postoperative critical care | Use when advanced practice clinicians provide critical care services related to the operative admission (if applicable). |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
208600000X | Surgery Physician | General surgeons performing breast-conserving resections and axillary node procedures. |
207RH0003X | Surgical Oncology Physician | Surgeons specializing in oncologic breast surgery and complex axillary management. |
207N00000X | Dermatology Physician | Occasionally involved for skin-sparing approaches or local lesion management when skin excision is required. |
207RG0100X | Gastroenterology Physician | Data provided; not commonly performing this procedure but listed in associated taxonomies. |
207RI0200X | Vascular Surgery Physician | Data provided; not typically performing breast resections but listed in associated taxonomies. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
C50.911 | Malignant neoplasm of unspecified site of right female breast | Primary malignant diagnosis prompting partial mastectomy with axillary staging on the right side. |
C50.912 | Malignant neoplasm of unspecified site of left female breast | Primary malignant diagnosis prompting partial mastectomy with axillary staging on the left side. |
D05.11 | Lobular carcinoma in situ of right breast | In situ lesion that may prompt excisional management or influence surgical planning on the right. |
D05.12 | Lobular carcinoma in situ of left breast | In situ lesion that may prompt excisional management or influence surgical planning on the left. |
Z85.3 | Personal history of malignant neoplasm of breast | Relevant for surveillance, reconstruction planning, or contralateral procedures in patients with prior breast cancer. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
19301 | Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy) | Alternative CPT for breast-conserving surgery; 19302 differs by explicit inclusion of axillary lymph node removal. |
19307 | Mastectomy, modified radical, including axillary lymph nodes, with or without pectoralis minor muscle, but excluding pectoralis major muscle | More extensive procedure when full mastectomy with axillary dissection is required instead of a segmental resection. |
38500 | Biopsy or excision of lymph node(s); open, superficial | May be used for isolated superficial nodal biopsies separate from the primary breast resection. |
38525 | Biopsy or excision of lymph node(s); open, deep axillary node(s) | Used when a discrete deep axillary node excision is performed in addition to or instead of sentinel node techniques. |
38745 | Axillary lymphadenectomy; complete | Used for a full axillary dissection when multiple level node removal is required beyond sentinel or targeted node biopsy. |
38900 | Intraoperative identification (eg, mapping) of sentinel lymph node(s) includes injection of non-radioactive dye, when performed (List separately in addition to code for primary procedure) | Billed in addition to 19302 when sentinel node mapping/identification is performed during the same operative session. |