CPT 19020
Global 090 ActiveMastotomy expl drg absc dp
CPT 19020 Billing & Documentation Guide
CPT code 19020 (Mastotomy expl drg absc dp) is classified under Anesthesia with a global period indicator of 090. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 3.73, a non-facility practice expense RVU of 10.75, and a malpractice RVU of 0.92, a total non-facility RVU of 15.4 and facility RVU of 9.47. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $528.16, though rates vary from $448.84 to $672.52 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 19020, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 19020 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
90-day global period (major surgery: 1 day pre-op + procedure + 90 days post-op)
MUE Limit (Medically Unlikely Edits)
Submitting more than 2 units of 19020 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 19020
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 3.73 | 3.73 |
| Practice Expense RVU | 10.75 | 4.82 |
| Malpractice RVU | 0.92 | 0.92 |
| Total RVU | 15.4 | 9.47 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 19020
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $570.58 | $336.21 | $536.7 - $672.52 | 29 |
| Florida | $544.66 | $345.93 | $514.03 - $576.08 | 3 |
| Georgia | $504.09 | $315.13 | $481.5 - $526.67 | 2 |
| Illinois | $530.69 | $339.31 | $500.44 - $556.84 | 4 |
| Michigan | $505 | $319.01 | $487.1 - $522.89 | 2 |
| North Carolina | $479.22 | $294.43 | $479.22 - $479.22 | 1 |
| New York | $572.83 | $351.87 | $487.29 - $616.54 | 5 |
| Ohio | $483.38 | $302.55 | $483.38 - $483.38 | 1 |
| Pennsylvania | $510.26 | $316.25 | $483.24 - $537.27 | 2 |
| Texas | $507.31 | $312.31 | $479.88 - $531.95 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 19020
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 19020 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 00400 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 0213T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0216T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0228T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0230T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0596T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0597T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0903T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0904T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0905T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 19020
What does CPT code 19020 mean? +
CPT code 19020 represents: Mastotomy expl drg absc dp. It's in the Anesthesia category with a global period of 090.
What is the Medicare reimbursement for CPT 19020? +
The 2026 Medicare national average non-facility payment for CPT 19020 is $528.16. Rates range from $448.84 to $672.52 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 19020? +
Surgery codes commonly use modifier 22 (increased procedural services), 50 (bilateral), 51 (multiple procedures), 52 (reduced services), 58/78/79 (staged, unplanned return, unrelated within global), 62 (co-surgeons), 80/82 (assistant surgeon), and 59 or the X{EPSU} subset for distinct procedural service.
What bundling edits apply to CPT 19020? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on June 2, 2026.
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