North Dakota Blue Cross and Blue Shield (BCBSND) has identified an increase in providers billing CPT 19499, Unlisted Procedure, Breast. Review of medical records identified 19499 was being used for breast biopsies performed with stereotactic and Tomosynthesis image guidance.
The American Medical Association (AMA)/ American College of Radiology (ACR) Clinical Examples in Radiology Fall 2016 issue, provides guidance on the reporting of both a stereotactic and tomosynthesis imaging-guided core breast biopsy as follows:
“When a breast biopsy is performed using both stereotactic and tomosynthesis imaging guidance, it is appropriate to use CPT code 19081, Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including stereotactic guidance.
If a combination stereotactic–tomosynthesis guided biopsy is performed using a separate piece of equipment (such as a prone table) and the patient is moved to another unit for a post-procedure mammogram, it is appropriate to report the post-procedure mammogram separately. If the combination stereotactic–tomosynthesis guided biopsy is performed using a standard digital breast tomosynthesis mammography unit on which the post-procedure mammogram is also obtained, it is not appropriate to report the post-procedure mammogram separately.”
Providers should only bill 19499 for breast biopsies performed using only tomosynthesis imaging guidance. Providers submitting unlisted codes must submit the following on the claim form:
CMS-1500 Claim Form
UB04 Claim Form
Breast Biopsies |
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Imaging Guidance Used |
Tomosynthesis Imaging Only |
Stereotactic Imaging Only |
Tomosynthesis & Stereotactic | Ultrasound |
MRI |
Without Guidance |
Codes |
19499 |
19081 |
19081 |
19083 |
19085 |
19100 |
Additional Lesions |
19499-59 |
19082 |
19082 |
19084 |
19086 |
|
Notes |
Breast biopsy include:
Bilateral Biopsies – Refer to the Bilateral Procedure Reimbursement Policy |
Descriptions |
|
19081 |
Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including stereotactic guidance |
19082 |
Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; each additional lesion, including stereotactic guidance (List separately in addition to code for primary procedure) |
19083 |
Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including ultrasound guidance |
19084 |
Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; each additional lesion, including ultrasound guidance (List separately in addition to code for primary procedure) |
19085 |
Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including magnetic resonance guidance |
19086 |
Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; each additional lesion, including magnetic resonance guidance (List separately in addition to code for primary procedure) |
19100 |
Biopsy of breast; percutaneous, needle core, not using imaging guidance (separate procedure) |
19101 |
Biopsy of breast; open, incisional |
19499 |
Unlisted procedure, breast |
Resources |
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American College of Radiology |
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Applied Radiology |
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Noridian |
While reimbursement is considered, payment determination is subject to, but not limited to:
In instances where the provider is participating, based on member benefits, co-payment, coinsurance, and/or deductible shall apply.
Reimbursement policies are intended only to establish general guidelines for reimbursement under BCBSND plans. BCBSND retains the right to review and update its reimbursement policy guidelines at its sole discretion.