Summary & Overview
CPT 19306: Radical Mastectomy with Chest Wall and Lymphadenectomy
CPT code 19306 represents a radical mastectomy: removal of the entire breast, nipple–areolar complex, pectoral muscles, and axillary plus internal mammary lymph nodes. As one of the most extensive breast cancer surgeries, this code signals major operative intervention and substantial postoperative resource use. Nationally, accurate coding for this procedure affects surgical quality reporting, facility and professional payment, and oncology care pathway documentation.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of coding intent and clinical context, typical sites of service, and common billing modifiers associated with major surgical procedures. The publication outlines benchmarking considerations for service lines that manage complex breast oncology cases and highlights policy and coverage topics that commonly influence authorization and payment.
This report helps clinicians, billing staff, and policy analysts by clarifying the clinical scope of CPT code 19306, summarizing payer coverage landscape, and identifying operational implications for hospitals and surgical oncology programs. Data not available in the input where specific payer policies, ICD-10 mappings, or related codes would normally be listed.
Billing Code Overview
CPT code 19306 describes a radical mastectomy in which the provider removes the entire breast, nipples, skin surrounding the nipple–areolar complex, the pectoral (chest) muscles, and axillary and internal mammary lymph nodes. This procedure is a major oncologic surgical operation performed to treat or control locally advanced breast cancer or extensive chest wall involvement.
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Service type: Major surgical oncology procedure (radical mastectomy)
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Typical site of service: Inpatient surgical setting or hospital operating room with postoperative inpatient care
Clinical & Coding Specifications
Clinical Context
A 58-year-old female with a newly diagnosed, locally advanced invasive ductal carcinoma of the right breast presents for definitive surgical management. Preoperative staging with breast MRI and PET/CT identified involvement of the nipple–areolar complex and suspicious axillary and internal mammary lymph nodes. The multidisciplinary tumor board recommended primary resection with removal of the entire breast, overlying skin including the nipple–areolar complex, pectoral muscles if directly involved, and regional lymphadenectomy. The patient is consented for a radical mastectomy under general anesthesia. In the operating room, the surgical team performs en bloc removal of the breast tissue and skin, dissects and removes level I–III axillary lymph nodes, and samples internal mammary nodes through the mastectomy incision or separate access as indicated. Intraoperative frozen section may be used for margin assessment. Postoperative care includes pain control, wound care, drain management, pathology review for staging, and coordination of adjuvant therapy (chemotherapy, radiation, or endocrine therapy) based on final pathology and receptor status.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
50 | Bilateral procedure | Use when bilateral radical mastectomies are performed in the same operative session. |
51 | Multiple procedures | Use when the mastectomy is billed with additional distinct surgical procedures at the same session (e.g., reconstruction) that are not part of the primary service. |
52 | Reduced services | Use when the surgeon performs a substantially reduced service compared to the full-described procedure. |
53 | Discontinued procedure | Use when the procedure is started but discontinued due to extenuating circumstances. |
54 | Surgical care only | Use when only the surgical portion is billed and another provider bills for pre/postoperative care. |
55 | Postoperative management only | Use when only postoperative care is billed by the surgeon. |
62 | Two surgeons | Use when two surgeons work together as primary surgeons performing distinct portions of the radical mastectomy. |
66 | Surgical team | Use when a surgical team (multiple surgeons) is required for complex cases. |
80 | Assistant surgeon | Use when an assistant surgeon provides assistance with the radical mastectomy. |
81 | Minimum assistant surgeon | Use when a minimum assistant is required (e.g., resident under supervision qualifying for reimbursement). |
22 | Increased procedural services | Use when the procedure requires substantially greater work (e.g., extensive resection, reconstruction of chest wall). |
26 | Professional component | Use if a distinct professional component is reported separately for a related service (rare for this operative CPT). |
73 | Discontinued outpatient hospital/ASC prior to anesthesia | Use when the outpatient mastectomy is discontinued before anesthesia. |
78 | Unplanned return to OR for related procedure by same surgeon | Use when the patient returns to the OR during the global period for a related procedure (e.g., hemorrhage control). |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207RA0500X | General Surgery | Most common specialty performing mastectomy and axillary dissection. |
| 207RP1001X | Surgical Oncology | Specialists focused on oncologic breast surgery and complex resections. |
| 207RH0000X | Plastic and Reconstructive Surgery | Frequently involved when immediate reconstruction is planned. |
| 2080S0001X | Thoracic Surgery | May be involved if pectoral/ chest wall or internal mammary node access requires thoracic expertise. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
C50.911 | Malignant neoplasm of unspecified site of right female breast | Primary cancer indication for mastectomy when tumor location is specified to the right breast. |
C50.912 | Malignant neoplasm of unspecified site of left female breast | Primary cancer indication for mastectomy when tumor location is specified to the left breast. |
C50.919 | Malignant neoplasm of unspecified site of breast, unspecified | Used when laterality or breast side is not otherwise specified in documentation. |
C79.81 | Secondary malignant neoplasm of breast | May be used when the breast contains metastatic disease from another primary requiring mastectomy in select cases. |
Z90.11 | Acquired absence of right breast and nipple | Relevant for history coding when documenting prior contralateral breast removal or reconstruction in the chart; affects surgical planning. |
Z85.3 | Personal history of malignant neoplasm of breast | Important in preoperative history and surveillance planning; may influence bilateral procedures. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
19307 | Modified radical mastectomy — removal of breast tissue with axillary lymph node dissection, sparing pectoral muscles | Often selected when pectoral muscles are not removed; alternative to the more extensive radical mastectomy. |
19340 | Immediate insertion of breast prosthesis following mastopexy, mastectomy, or in reconstruction | Performed at the same operative session when immediate prosthetic reconstruction is chosen. |
19342 | Immediate insertion of tissue expander following mastectomy | Used when a tissue expander is placed for staged reconstruction during the same admission. |
38745 | Intraoperative lymphatic mapping and sentinel node biopsy | May be performed before or during axillary dissection to identify sentinel nodes or guide extent of lymphadenectomy. |
38900 | Biopsy or excision of lymph node(s) (open) | Used for targeted open biopsy of internal mammary or other suspicious nodes that are excised separately. |