CPT 19303: Simple Mastectomy, Removal of Breast and Nipple–Areolar Complex
CPT code 19303 represents a simple mastectomy — complete removal of the breast and nipple–areolar complex with preservation of the pectoralis muscles and axillary nodes. This surgical procedure is a core oncologic and risk-reduction service in breast care and influences care pathways, inpatient and outpatient surgical utilization, and resource allocation across hospitals and ambulatory surgery centers nationwide. The code matters for surgical quality measurement, payer coverage determinations, and care coordination for patients undergoing definitive breast surgery.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. Readers will find a concise clinical context for 19303, typical sites of service, common ICD-10 diagnoses associated with its use, and related CPT surgical codes for comparison. The publication outlines billing and coding considerations relevant to surgical oncology and reconstructive care, summarizes common modifiers used with the code, and highlights where 19303 intersects with plastic surgery and dermatologic surgical practices. The content provides national-level benchmarks and policy-relevant points to help providers, coders, and administrators understand how 19303 is documented and categorized in payer interactions and surgical service lines.
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Billing Code Overview
CPT code 19303 describes a simple mastectomy in which the provider removes the entire breast, nipples, and surrounding nipple–areolar complex skin while preserving the pectoralis major and minor muscles and leaving axillary lymph nodes in place. This procedure is a surgical breast removal typically performed for definitive treatment of breast cancer, high-risk lesions, or other clinical indications requiring removal of breast tissue.
Service Type: Surgical excision / Mastectomy
Typical Site of Service: Hospital operating room or ambulatory surgical center, depending on patient condition, complexity of the procedure, and facility capabilities.
National Reimbursement Benchmarks
Medicare averages roughly $925.60, while BUCA’s mean commercial rate is $2,967.50, indicating BUCA sits about $2,041.90 above Medicare on average for CPT 19303. This gap highlights a substantial lift in commercial reimbursements versus the Medicare baseline, with BUCA nearer to the upper-middle of commercial payers’ mean rates rather than the low end.
Dispersion (P75–P25) varies across payers: Blue Cross Blue Shield shows the widest spread at $4,613.70 ($5,750.00 − $1,136.30), followed by BUCA at $3,132.30 ($4,176.20 − $1,043.90) and Aetna at $1,303.00 ($2,132.20 − $829.70). The tightest spreads are Cigna at $1,102.20 and UnitedHealth Group at $1,066.40, signaling more concentrated commercial rate bands for those payers.