Summary & Overview
CPT 19307: Mastectomy, Removal of Entire Breast
CPT code 19307 denotes a mastectomy, the surgical removal of an entire breast. This code captures a high-acuity surgical service with significant clinical, billing, and policy implications across the U.S. health system. Mastectomy services affect hospital surgical volume, facility and professional reimbursement, and outcomes reporting for breast cancer care and risk-reducing procedures.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of how CPT code 19307 is classified clinically, typical sites of service where the procedure is delivered, and the payer landscape relevant to coverage and claims processing. The publication also summarizes benchmarks commonly reviewed for major breast surgery, highlights policy and coding considerations that influence reimbursement and claims adjudication, and provides clinical context for when a mastectomy is coded.
This national-level summary is intended for billing administrators, practice managers, clinical coders, and policy analysts seeking a concise reference on the role of CPT code 19307 in surgical breast care, payer coverage patterns, and the operational settings where the procedure is performed.
Billing Code Overview
CPT code 19307 describes a mastectomy, the surgical removal of the entire breast. The service type is a major surgical procedure in breast surgery, typically performed for therapeutic indications such as breast cancer or risk-reducing surgery. The typical site of service is an acute care hospital operating room or an ambulatory surgical center, depending on clinical factors and payer policies.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is a woman diagnosed with invasive breast cancer or high-risk preinvasive disease scheduled for a total mastectomy (19307) to remove the entire breast tissue. The patient presents after diagnostic workup including mammography, ultrasound, and core needle biopsy confirming malignancy (for example, invasive ductal carcinoma). Preoperative workflow includes surgical oncology consultation, informed consent discussing risks/benefits and reconstruction options, preoperative medical clearance, and coordination with anesthesia. On the day of service the procedure is performed in an ambulatory surgical center or hospital operating room under general anesthesia. The surgery may be unilateral or bilateral (modifier 50 for bilateral when applicable), and may be followed by immediate reconstruction (e.g., implant or autologous reconstruction) or sent to pathology for margin assessment. Typical postoperative workflow includes pain management, wound care instructions, coordination of adjuvant therapy (chemotherapy, radiation, endocrine), and pathology-driven staging and treatment planning.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
50 | Bilateral procedure | Append when both breasts undergo mastectomy during the same operative session. |
LT | Left side | Use to indicate the procedure was performed on the left breast when payer requires laterality. |
RT | Right side | Use to indicate the procedure was performed on the right breast when payer requires laterality. |
22 | Increased procedural services | Use when intraoperative work is substantially greater than typical (complex resection, extensive dissection). |
52 | Reduced services | Use when the procedure is partially reduced or not completed as described by the code (aborted or limited mastectomy). |
53 | Discontinued procedure | Use when surgery is started but discontinued due to extenuating circumstances. |
59 | Distinct procedural service | Use to indicate a separate, unrelated procedure or modifier XS/XP/XU per payer policy for distinct operative work. |
62 | Two surgeons | Use when two surgeons with different specialties operate together, each contributing distinct surgical components. |
79 | Unrelated procedure or service by the same physician during postoperative period | Use when an unrelated surgical procedure is performed by the same surgeon during the global period. |
22 | (already listed) | (avoid duplication) |
76 | Data not provided in input | Data not available in the input. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 2080S0001X | Surgery - Surgical Oncology | Primary specialty performing mastectomy for breast cancer. |
| 208000000X | Surgery - General Surgery | General surgeons often perform mastectomy procedures. |
| 207XS0102X | Surgery - Plastic Reconstructive | Plastic surgeons perform immediate or delayed reconstruction following mastectomy. |
| 207RC0000X | Surgery - Reconstructive Plastic Surgery | Reconstructive focus for post-mastectomy breast reconstruction. |
| 207K00000X | Surgery - Cancer Surgery | Oncologic surgical specialists involved in complex breast resections. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
C50.911 | Malignant neoplasm of unspecified site of right female breast | Right-sided invasive breast cancer commonly treated with mastectomy when indicated. |
C50.912 | Malignant neoplasm of unspecified site of left female breast | Left-sided invasive breast cancer treated with mastectomy when indicated. |
D05.91 | Unspecified intraductal carcinoma in situ of breast | High-risk or extensive DCIS may be managed with mastectomy. |
Z90.13 | Acquired absence of both breasts | Postoperative status code used after bilateral mastectomy for permanent record. |
Z85.3 | Personal history of malignant neoplasm of breast | Used in patients with prior breast cancer; may influence therapeutic decisions including completion mastectomy or prophylactic surgery. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
19340 | Immediate insertion of breast prosthesis following mastectomy (single stage) | Performed when immediate implant-based reconstruction is done at the time of mastectomy. |
19342 | Delayed insertion of breast prosthesis following mastopexy, periprosthetic procedures | Used for delayed implant reconstruction after mastectomy in a later operative session. |
19357 | Tissue expander placement in breast reconstruction | Commonly performed immediately after mastectomy to prepare the breast pocket for later implant placement. |
19499 | Unlisted procedure, breast | Used for atypical or novel reconstructive techniques not described by existing codes; requires documentation. |
88305 | Surgical pathology, gross and microscopic examination | Pathology examination of mastectomy specimen for diagnosis, margins, and staging; submitted separately by pathology services. |