Summary & Overview

CPT 19499: Unlisted Procedure on the Breast

CPT code 19499 designates an unlisted breast procedure and is used when a breast surgery or intervention lacks a specific CPT descriptor. Nationally, unlisted procedure codes like 19499 matter because they require additional documentation and often trigger case-by-case review, medical necessity assessment, and individualized pricing. This affects billing workflows, prior authorization processes, and claims adjudication across payers.

Key payers in this coverage snapshot include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise briefing on clinical context for using 19499, payer coverage patterns, and the operational implications of filing an unlisted breast procedure code. The publication outlines common modifiers used with unlisted procedural claims, expected documentation to accompany claims, and considerations for site-of-service variability.

The report provides benchmarks and policy context relevant to payers and provider billing teams, including guidance on documentation expectations and typical review triggers for unlisted breast procedures. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare19499CPTbreast-surgeryunlisted-proceduresurgical-billingclaims-documentationprior-authorizationoutpatient-surgery

Billing Code Overview

CPT code 19499 is an unlisted procedure code used to report a procedure on the breast for which there is no specific CPT code. This code represents atypical or uncommon breast procedures that do not have designated codes and is intended to capture services that fall outside standard coded breast surgeries.

Service type: Surgical procedure on the breast.

Typical site of service: Hospital outpatient department, ambulatory surgical center, or inpatient surgical setting, depending on clinical context and procedure complexity.

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient is a 48-year-old female presenting with a complex breast lesion that does not match an existing CPT-specific procedure. She has a symptomatic, atypical mass discovered on diagnostic mammography and ultrasound, with prior inconclusive core needle biopsy. After multidisciplinary review, the surgical team schedules a targeted breast procedure that is atypical in technique or extent (for example, an uncommon excisional approach, combined reconstructive step, or novel image-guided removal) and is therefore reported with 19499. The typical workflow includes preoperative imaging and localization (if needed), informed consent detailing the atypical nature of the procedure, intraoperative documentation of the unique technique or combined services, and postoperative pathology and follow-up. Typical site of service is an ambulatory surgical center or hospital outpatient department. The service type is an unlisted breast surgical procedure used when no specific code accurately describes the operative service.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when the unlisted breast procedure requires substantially greater effort, time, or complexity than usual and documentation supports unusual difficulty.

Taxonomy Code	Specialty	Notes
`208000000X`	General Surgery	Most common specialty performing complex or unlisted breast surgical procedures.
`208600000X`	Plastic Surgery	Frequently involved for combined resection and reconstructive techniques.
`207W00000X`	Surgical Oncology	Performs oncologic breast operations that may require unlisted coding for novel techniques.
`363L00000X`	Radiology - Diagnostic	Interventional radiologists may perform atypical image-guided breast procedures that could be reported as unlisted when no specific code exists.
`207X00000X`	Breast Surgery	Specialty-focused breast surgeons performing complex or unusual breast procedures.

ICD-10 Code	Description	Clinical Relevance
`D24.9`	Benign neoplasm of breast, unspecified	Common indication for excision when lesion is atypical or not covered by standard codes.
`N63`	Unspecified lump in breast	Typical presenting symptom prompting an atypical surgical approach when standard codes don't fit.
`R92.8`	Other abnormal and inconclusive findings on diagnostic imaging of breast	Imaging findings that lead to an unlisted operative approach.
`R92.1`	Other abnormal findings on diagnostic imaging of breast	Imaging abnormalities that may necessitate nonstandard surgical technique.
`C50.912`	Malignant neoplasm of unspecified site of right female breast	Malignant lesions sometimes require nonstandard combined techniques reported with `19499` when not otherwise specified.
`C50.911`	Malignant neoplasm of unspecified site of left female breast	As above, for left-sided malignancy requiring atypical operative management.
`N60.32`	Fibrosclerosis of right breast	Benign but complex pathology that may require unique excisional techniques.
`N60.31`	Fibrosclerosis of left breast	As above for left breast pathology.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`19000`	Puncture aspiration of breast cyst, single or multiple, without imaging guidance; simple aspiration	May be performed during diagnostic workup prior to an unlisted excisional or novel procedure when cystic components are present.
`19001`	Puncture aspiration of breast cyst, with imaging guidance; single or multiple	Image-guided aspiration often precedes or accompanies atypical breast procedures and may be billed separately when applicable.
`19120`	Excision of cyst, fibroadenoma, or other benign or malignant tumor, open, of breast; single lesion	Standard excisional code; when the procedure does not fit `19120` due to technique or extent, `19499` is used instead.
`19301`	Partial mastectomy (lumpectomy), single lesion, including simple closure	Common oncologic breast-conserving procedure; a novel or combined technique not described by `19301` may be reported with `19499`.
`19318`	Reduction mammaplasty	Performed when additional reconstructive or reduction maneuvers are combined with an excision and the combined service lacks a specific code.
`15777`	Implantation of biologic implant (eg, ADM) for soft tissue reinforcement (breast)	May be performed contemporaneously for reconstruction; if combination is atypical and no specific code exists, `19499` can capture the unlisted breast component.

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