CPT 19112
Global 090 ActiveExcise breast duct fistula
CPT 19112 Billing & Documentation Guide
CPT code 19112 (Excise breast duct fistula) is classified under Anesthesia with a global period indicator of 090. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 3.71, a non-facility practice expense RVU of 10.42, and a malpractice RVU of 1.01, a total non-facility RVU of 15.14 and facility RVU of 9.91. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $518.55, though rates vary from $440.25 to $657.5 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 19112, 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 19112 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 19112 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 19112
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 3.71 | 3.71 |
| Practice Expense RVU | 10.42 | 5.19 |
| Malpractice RVU | 1.01 | 1.01 |
| Total RVU | 15.14 | 9.91 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 19112
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 | $558.48 | $351.78 | $525.55 - $657.5 | 29 |
| Florida | $538.78 | $363.51 | $507.34 - $571.54 | 3 |
| Georgia | $496.5 | $329.85 | $474.58 - $518.41 | 2 |
| Illinois | $525.11 | $356.32 | $494.4 - $551.98 | 4 |
| Michigan | $498.21 | $334.17 | $479.76 - $516.65 | 2 |
| North Carolina | $470.19 | $307.21 | $470.19 - $470.19 | 1 |
| New York | $563.93 | $369.05 | $478.27 - $608.31 | 5 |
| Ohio | $475.68 | $316.19 | $475.68 - $475.68 | 1 |
| Pennsylvania | $502 | $330.89 | $475.3 - $528.7 | 2 |
| Texas | $498.58 | $326.6 | $471.97 - $522.28 | 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 19112
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 19112 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 19112
What does CPT code 19112 mean? +
CPT code 19112 represents: Excise breast duct fistula. It's in the Anesthesia category with a global period of 090.
What is the Medicare reimbursement for CPT 19112? +
The 2026 Medicare national average non-facility payment for CPT 19112 is $518.55. Rates range from $440.25 to $657.5 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 19112? +
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 19112? +
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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