Summary & Overview
CPT 19304: Mastectomy, Subcutaneous
CPT code 19304 denotes a subcutaneous mastectomy, a surgical procedure that removes breast tissue while often preserving skin and the nipple-areolar complex. This code is used across surgical and reconstructive workflows and is relevant to oncology, general surgery, and plastic surgery practices. Nationally, accurate use of CPT code 19304 matters for clinical documentation, surgical quality measurement, and correct claims processing for breast cancer and related breast disease.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for 19304, how it relates to common breast surgery pathways, and the typical sites of service. The publication highlights related procedure codes commonly encountered alongside 19304, outlines typical ICD-10 diagnoses associated with the service, and identifies relevant clinical specialties.
This report provides operational benchmarks and coding context useful for billing teams, surgical practices, and policy analysts. It summarizes common billing relationships with reconstruction and related mastectomy codes and points to diagnostic indications often paired with the procedure. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 19304 describes mastectomy, subcutaneous. This procedure involves removal of breast tissue while preserving the skin and nipple-areolar complex when clinically appropriate. The service type is surgical (breast surgery). The typical site of service is an acute care hospital operating room or outpatient surgical center.
Clinical & Coding Specifications
Clinical Context
A 54-year-old woman presents after diagnostic mammography and core needle biopsy confirming ductal carcinoma in situ in the upper-outer quadrant of the right breast. Clinical evaluation and shared decision-making between the surgical oncologist and the patient result in an operative plan for a 19304 subcutaneous (skin-sparing) mastectomy with planned sentinel lymph node biopsy under the same anesthesia. The typical workflow includes preoperative surgical clearance, marking of the breast and planned incision in the preoperative area, induction of general anesthesia in the operating room, intraoperative resection of the breast glandular tissue while preserving the skin envelope and nipple-areolar complex when oncologically appropriate, and immediate specimen orientation and submission to pathology. Postoperative care includes monitoring in the PACU, pain control, wound care instructions, and follow-up appointments for pathology review and reconstruction planning if indicated. Typical site of service is an ambulatory surgical center or hospital outpatient surgical unit. Common payors involved include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the day of the procedure | Use when a distinct E/M visit is performed and documented the same day as 19304 for issues such as preoperative assessment or new diagnostic discussions |
26 | Professional component | Use if a billing split occurs and the physician bills only the professional component of a service related to the procedure |
50 | Bilateral procedure | Use when a bilateral subcutaneous mastectomy is performed and payer requires the bilateral modifier rather than modifier RT/LT |
51 | Multiple procedures | Use when 19304 is reported with additional unrelated surgical procedures in the same operative session |
57 | Decision for surgery | Use when E/M leading to the decision for surgery occurs the day before or on the day of surgery as the primary reason for the encounter |
59 | Distinct procedural service | Use to indicate a distinct procedural service that is not normally reported together with another service |
78 | Return to the operating room after the initial procedure for a related procedure during the postoperative period | Use if the patient requires an unplanned return to OR for a related complication following 19304 |
79 | Unrelated procedure or service by the same physician during the postoperative period | Use when an unrelated procedure is performed by the same surgeon during the global period of 19304 |
LT | Left side | Use to indicate the procedure was performed on the left breast when payor requires laterality modifiers |
RT | Right side | Use to indicate the procedure was performed on the right breast when payor requires laterality modifiers |
GA | Waiver of liability statement on file (Medicare) | Use when a voluntary ABN is on file and the payer requires documentation of patient consent for services that may be non-covered |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
208600000X | Surgery Physician | General and surgical oncologists commonly perform oncologic mastectomy procedures |
208200000X | Plastic Surgery Physician | Plastic surgeons participate for reconstruction planning or immediate reconstruction |
207N00000X | Dermatology Physician | Dermatologic surgeons may be involved in limited breast-skin procedures or consults |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
C50.911 | Malignant neoplasm of unspecified site of right female breast | Oncologic indication for right-sided 19304 when tumor is confined to breast tissue and skin preservation is oncologically acceptable |
C50.912 | Malignant neoplasm of unspecified site of left female breast | Oncologic indication for left-sided 19304 with similar considerations for skin-sparing technique |
D05.10 | Carcinoma in situ of unspecified breast | Non-invasive cancer often managed with mastectomy when breast-conserving therapy is not chosen or feasible |
N63 | Unspecified lump in breast | Symptomatic or diagnostic finding that may lead to surgical excision and definitive management including mastectomy if malignant or extensive |
Z85.3 | Personal history of malignant neoplasm of breast | Relevant for planning risk-reducing contralateral or prophylactic 19304 in patients with prior breast cancer |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
19303 | Mastectomy, simple, complete | Alternative mastectomy technique; may be selected instead of 19304 when skin removal is required |
19307 | Mastectomy, modified radical | More extensive procedure including axillary dissection; performed when nodal dissection is indicated beyond sentinel node biopsy |
19340 | Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction | May be performed immediately following 19304 when prosthetic reconstruction is planned in the same operative session |
19357 | Breast reconstruction, immediate or delayed, with tissue expander | Used when staged reconstruction with a tissue expander is performed following 19304, either immediate or delayed |