Summary & Overview
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.
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.
Clinical & Coding Specifications
Clinical Context
A 56-year-old woman with a biopsy-proven invasive ductal carcinoma of the right breast (C50.911) presents after multidisciplinary tumor board discussion. Imaging demonstrates a centrally located tumor with involvement of the nipple–areolar complex and multifocal disease not amenable to breast-conserving surgery. The surgical plan is a total mastectomy (19303) to remove the entire breast, nipple, and surrounding areolar skin while preserving the pectoralis major and minor muscles and axillary nodes.
Preoperative workflow includes surgical consent, review of prior pathology and imaging, anesthesia evaluation, and preoperative marking. In the operating room the surgeon performs the mastectomy; intraoperative frozen section or sentinel lymph node sampling may be performed by the surgical oncology team as indicated. Postoperative care includes recovery room monitoring, pain control, wound assessment, and outpatient follow-up for pathology review and discussion of adjuvant therapy. Reconstruction planning with a plastic surgeon may occur during the same encounter or at a later date depending on patient preference and clinical factors.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
50 | Bilateral procedure | When bilateral 19303 procedures are performed in the same operative session. |
52 | Reduced services | When the mastectomy is attempted but only partially completed or abbreviated for clinical reasons. |
53 | Discontinued procedure | When the procedure is aborted after anesthesia induction due to unforeseen complications. |
59 | Distinct procedural service | When a separate, distinct surgical procedure is performed at a different site or session from the mastectomy. |
62 | Two surgeons | When two surgeons with different specialties perform distinct portions of the mastectomy (eg, oncologic resection and complex reconstruction). |
63 | Procedure performed on infants less than 4 kg | Rarely applicable but used if patient meets weight criteria. |
76 | Repeat procedure by same physician | If an additional mastectomy is performed by the same surgeon during the postoperative period for complications or revision. |
78 | Unplanned return to the operating room for a related procedure during the postoperative period | For reoperation related to 19303 wound complication or hemorrhage. |
79 | Unrelated procedure or service by the same physician during the postoperative period | When an unrelated procedure is performed during the global period. |
22 | Increased procedural services | When work required to perform 19303 is substantially greater than typical (documented). |
26 | Professional component | If only the surgeon's professional component is billed separate from technical charges by the facility. |
TC | Technical component | When billing only the technical component (facility) for services associated with the procedure. |
LT | Left side | When the mastectomy is performed on the left breast (C50.912). |
RT | Right side | When the mastectomy is performed on the right breast (C50.911). |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
208600000X | Surgery Physician | General surgeons commonly perform therapeutic mastectomy for breast cancer. |
2086S0122X | Surgical Oncology Physician | Surgical oncologists frequently lead oncologic breast resections and sentinel node management. |
208800000X | Plastic Surgery Physician | Plastic surgeons perform immediate or delayed reconstruction planning and procedures. |
207N00000X | Dermatology Physician | Dermatologists are less commonly involved but may be consulted for complex skin or soft tissue considerations in planning incisions. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
C50.911 | Malignant neoplasm of unspecified site of right female breast | Primary oncologic indication for right-sided mastectomy 19303. |
C50.912 | Malignant neoplasm of unspecified site of left female breast | Primary oncologic indication for left-sided mastectomy 19303. |
D05.10 | Carcinoma in situ of unspecified breast | Indicates in situ disease when mastectomy may be chosen for disease extent or patient preference. |
Z85.3 | Personal history of malignant neoplasm of breast | History of prior breast cancer influencing surgical planning, reconstruction, or surveillance. |
N63 | Unspecified lump in breast | Presenting symptom that may lead to diagnostic workup culminating in mastectomy if malignant. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
19307 | Mastectomy, modified radical, including axillary lymph nodes, with or without pectoralis minor muscle, but excluding pectoralis major muscle | Alternative mastectomy when axillary lymph node dissection is required; more extensive than 19303 if nodes are removed concurrently. |
19316 | Mastopexy | Performed by plastic surgery as part of reconstructive or aesthetic planning following mastectomy; may occur in staged reconstruction. |
19318 | Reduction mammoplasty | May be employed in contralateral breast symmetry procedures when reconstruction is performed. |
38900 | Intraoperative lymphatic or sentinel node procedure (example code for sentinel node biopsy) | Sentinel lymph node biopsy or intraoperative node evaluation is often performed during mastectomy to stage disease. |
15777 | Application of tissue substitute (eg, ADM) during breast reconstruction | Used by plastic surgeons when immediate reconstruction with implants requires acellular dermal matrix adjuncts. |