CPT 19100
Global 000 ActiveBx breast percut w/o image
CPT 19100 Billing & Documentation Guide
CPT code 19100 (Bx breast percut w/o image) is classified under Anesthesia with a global period indicator of 000. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 1.24, a non-facility practice expense RVU of 3.35, and a malpractice RVU of 0.3, a total non-facility RVU of 4.89 and facility RVU of 1.85. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $167.62, though rates vary from $142.69 to $212.69 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 19100, 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 19100 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
Endoscopic or minor procedure with related preoperative and postoperative work performed on the same day
MUE Limit (Medically Unlikely Edits)
Submitting more than 4 units of 19100 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 19100
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.24 | 1.24 |
| Practice Expense RVU | 3.35 | 0.31 |
| Malpractice RVU | 0.3 | 0.3 |
| Total RVU | 4.89 | 1.85 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 19100
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 | $180.74 | $60.59 | $170.13 - $212.69 | 29 |
| Florida | $173.19 | $71.31 | $163.45 - $183.24 | 3 |
| Georgia | $160.21 | $63.35 | $153.17 - $167.26 | 2 |
| Illinois | $168.83 | $70.72 | $159.24 - $177.16 | 4 |
| Michigan | $160.59 | $65.24 | $154.89 - $166.29 | 2 |
| North Carolina | $152.22 | $57.48 | $152.22 - $152.22 | 1 |
| New York | $181.83 | $68.56 | $154.76 - $195.72 | 5 |
| Ohio | $153.68 | $60.97 | $153.68 - $153.68 | 1 |
| Pennsylvania | $162.1 | $62.65 | $153.6 - $170.6 | 2 |
| Texas | $161.11 | $61.15 | $152.55 - $168.76 | 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 19100
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 19100 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 | CPT Separate procedure definition |
| 0904T | Column 1 (primary), can be billed with modifier | Yes | CPT Separate procedure definition |
| 0905T | Column 1 (primary), can be billed with modifier | Yes | CPT Separate procedure definition |
Frequently Asked Questions, CPT 19100
What does CPT code 19100 mean? +
CPT code 19100 represents: Bx breast percut w/o image. It's in the Anesthesia category with a global period of 000.
What is the Medicare reimbursement for CPT 19100? +
The 2026 Medicare national average non-facility payment for CPT 19100 is $167.62. Rates range from $142.69 to $212.69 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 19100? +
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 19100? +
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 May 31, 2026.
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