Summary & Overview
CPT 19305: Radical Mastectomy with Chest Wall and Axillary Lymph Node Removal
CPT code 19305 denotes a radical mastectomy involving removal of the entire breast, nipple–areolar complex, chest (pectoral) muscles, and axillary lymph nodes. It is a high-acuity surgical oncology procedure used for extensive or locally advanced breast cancer and remains clinically significant for definitive cancer control in selected patients. Nationally, accurate coding of this procedure affects clinical documentation, surgical quality measurement, and payment pathways for complex oncologic care.
This analysis covers major national payers including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, coding scope, common associated diagnoses, and related CPT references. The publication provides benchmarks and policy-relevant observations on coding alignment and procedural classification for radical mastectomy, plus guidance on where to locate supporting diagnosis codes in medical records.
Readers will learn what CPT code 19305 represents, why it matters for surgical oncology services, and how it connects to adjacent CPT codes for mastectomy. The report highlights clinical scenarios that commonly map to this code and summarizes the typical site of service and service type to support billing, coding review, and administrative oversight.
Billing Code Overview
CPT code 19305 describes a radical mastectomy in which the provider removes the entire breast, nipples, the skin surrounding the nipple–areolar complex, the pectoral (chest) muscles, and axillary lymph nodes. This procedure is an extensive oncologic surgery performed for invasive or locally advanced breast malignancies when removal of the chest wall musculature and regional lymph nodes is indicated.
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Service type: Surgical oncology procedure (radical mastectomy)
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Typical site of service: Hospital operating room or inpatient surgical unit
Clinical & Coding Specifications
Clinical Context
A 58-year-old female presents with a biopsy-proven invasive breast carcinoma of the right breast with radiographic evidence of multicentric disease and biopsy-proven axillary lymph node involvement. After multidisciplinary tumor board review, the surgical oncology team schedules a radical mastectomy given tumor extent and patient preference to avoid breast-conserving therapy. Preoperative assessment includes medical clearance, oncologic imaging (mammography, breast MRI, and chest imaging), and counseling on reconstructive options with a plastic surgeon. On the day of surgery the patient receives general anesthesia, and the surgical oncology physician performs removal of the entire right breast including the nipple–areolar complex, surrounding skin, underlying pectoral (chest) muscles as indicated by the radical approach, and ipsilateral axillary lymph node dissection. A separate plastic surgery consultation for immediate reconstruction may occur during the same operative session if planned. Postoperative workflow includes pathology review of the specimen, pain control, wound care, coordination of adjuvant therapies (chemotherapy, radiation, endocrine therapy) as indicated by final staging, and follow-up visits for incision checks and potential reconstructive staged procedures.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
50 | Bilateral procedure | Use when the radical mastectomy is performed on both breasts during the same operative session. |
| 62 | Two surgeons | Use when two surgeons of different specialties (e.g., surgical oncologist and plastic surgeon) operate together and both perform distinct parts of the radical mastectomy or complex reconstruction. |
| 51 | Multiple procedures | Use when additional distinct surgical procedures are performed at the same session in addition to the radical mastectomy (e.g., separate abdominal procedure for flap harvest billed by a different surgeon). |
| 52 | Reduced services | Use when the procedure is started but not completed or performed in a limited fashion relative to the full code descriptor. |
| 53 | Discontinued procedure | Use when the procedure is terminated due to patient instability or an intraoperative complication prior to completion. |
| 54 | Surgical care only | Use by the surgeon who performed only the operative portion when pre- and postoperative care is furnished by a different physician. |
| 55 | Postoperative management only | Use by a physician who provides only postoperative follow-up care for the surgical patient. |
| 26 | Professional component | Rarely applicable for this surgical code; use if a distinct professional interpretation component is billed separate from technical facility services (e.g., intraoperative pathology consultation billed separately). |
| 22 | Increased procedural services | Use when the work performed is substantially greater than typical (unusual complexity, extensive resection beyond typical), with documentation to support the increased work. |
| 73 | Discontinued outpatient procedure prior to anesthesia | Use when an outpatient radical mastectomy is cancelled prior to the administration of anesthesia. |
| 78 | Return to OR for related procedure during global period | Use when the patient returns to the operating room for a related procedure during the global surgical period due to complications. |
| 79 | Data not available in the input. |
| LT | Left side | Use to indicate the procedure was performed on the left breast when laterality needs explicit reporting. |
| RT | Right side | Use to indicate the procedure was performed on the right breast when laterality needs explicit reporting. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
208600000X | Surgery Physician | General surgeons with operative breast cancer expertise who may perform mastectomy procedures. |
| 2086S0122X | Surgical Oncology Physician | Specialty surgical oncologists who commonly perform radical mastectomy and axillary dissection. |
| 208800000X | Plastic Surgery Physician | Plastic and reconstructive surgeons involved when immediate or delayed reconstruction is planned.
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
C50.911 | Malignant neoplasm of unspecified site of right female breast | Primary oncologic indication for radical mastectomy when right breast cancer is present and extensive resection is required. |
| C50.912 | Malignant neoplasm of unspecified site of left female breast | Primary oncologic indication for radical mastectomy when left breast cancer is present and extensive resection is required. |
| D05.11 | Lobular carcinoma in situ of right breast | May be part of the risk profile or multifocal disease assessment; LCIS can influence surgical decision-making in select cases. |
| D05.12 | Lobular carcinoma in situ of left breast | As above for the left breast; may factor into extent of surgical management. |
| Z85.3 | Personal history of malignant neoplasm of breast | Indicates prior breast cancer history; may influence surveillance, contralateral risk-reducing surgery, or reconstruction planning. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
19303 | Mastectomy, simple, complete | Represents a less extensive mastectomy (skin-sparing/simple) compared with the radical approach; may be an alternative procedure depending on tumor extent. |
| 19306 | | Data not available in the input. |
| 19307 | | Data not available in the input. |