CPT 19125
Global 090 ActiveExcision breast lesion
CPT 19125 Billing & Documentation Guide
CPT code 19125 (Excision breast lesion) is classified under Anesthesia with a global period indicator of 090. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 6.52, a non-facility practice expense RVU of 10.81, and a malpractice RVU of 1.68, a total non-facility RVU of 19.01 and facility RVU of 13.55. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $647.07, though rates vary from $556.83 to $792.46 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 19125, 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 19125 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 1 units of 19125 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 19125
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 6.52 | 6.52 |
| Practice Expense RVU | 10.81 | 5.35 |
| Malpractice RVU | 1.68 | 1.68 |
| Total RVU | 19.01 | 13.55 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 19125
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 | $683.25 | $467.45 | $647.28 - $792.46 | 29 |
| Florida | $689.27 | $506.3 | $647.29 - $735.55 | 3 |
| Georgia | $629.69 | $455.72 | $606.73 - $652.66 | 2 |
| Illinois | $674.65 | $498.43 | $635.13 - $710.95 | 4 |
| Michigan | $635.8 | $464.54 | $610.78 - $660.81 | 2 |
| North Carolina | $590.5 | $420.35 | $590.5 - $590.5 | 1 |
| New York | $707.19 | $503.74 | $600.23 - $765.22 | 5 |
| Ohio | $603.99 | $437.48 | $603.99 - $603.99 | 1 |
| Pennsylvania | $633.38 | $454.75 | $602.26 - $664.5 | 2 |
| Texas | $626.56 | $447.02 | $598.47 - $655.26 | 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 19125
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 19125 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 19125
What does CPT code 19125 mean? +
CPT code 19125 represents: Excision breast lesion. It's in the Anesthesia category with a global period of 090.
What is the Medicare reimbursement for CPT 19125? +
The 2026 Medicare national average non-facility payment for CPT 19125 is $647.07. Rates range from $556.83 to $792.46 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 19125? +
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 19125? +
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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