Locality

or ZIP

Show values as

Switch every figure between Medicare dollars and work RVUs.

Conversion factor

19126

Excision addl breast lesion

Code typeAdd-on

Paid with — select a primary to see the real payable total

19125

Excision breast lesion

Add to my model

Code typePrimary

Payment statusActive (A)

Global period90-day

Pricing with Related Codes

Line

Qty

Global fee

Pro fee

Primary19125Excision breast lesion

$634.95

$452.58

Add-on19126Excision addl breast lesion

$143.96/ unit

Whole procedure · 6.52 wRVU credited

$634.95

$452.58

RVU Breakdown

Component

Office

Facility

Work

6.52

Practice expense

10.81

5.35

Malpractice

1.68

Total RVU

19.01

13.55

Payment Policy & Modifiers

Allowed adjustments

Bilateral -50150%

With modifier 50 (both sides), payment is 150% of the single-side amount. → $952.43 office.

Multiple procedure MPPRApplies

When billed with other procedures the same day: highest-valued paid 100%, the rest 50%. Add-on codes are exempt.

Co-surgeons -6262.5% each

Co-surgeons paid (62.5% each) if medical necessity is documented.

Not applicable to this code

Assistant surgeon Team surgeon -66Prof / tech split

Global surgery package

Major surgery: payment covers the day before, the day of, and 90 days after. Of the total payment, 10% is attributed to pre-operative care, 71% to the procedure itself, and 19% to post-operative visits.

In plain English

Office vs. facility

Where the service happens. In your own clinic (office), Medicare also pays you for the room, staff and supplies — so it's higher. In a hospital or ASC, the facility bills that part separately.

wRVU

Work Relative Value Units — the physician-effort share of a code. Most employment contracts pay a set dollar amount per wRVU, independent of Medicare's rate.

Add-on codes

Billed only alongside a primary code. Use the steppers to add units — extra levels, leads or sides — to the whole-procedure total.

Conversion factor

The dollars-per-RVU Medicare multiplies by. Set once, it flows through every figure on this page. The QP rate applies to clinicians who qualify as Advanced APM participants — a small annual boost.

GPCI

Geographic Practice Cost Index — adjusts the work, practice-expense and malpractice RVUs for your locality's cost of living before they're multiplied by the conversion factor.

How payment is computed

Each RVU is scaled by your locality's GPCI, summed, then multiplied by the conversion factor:

(work·wGPCI
+ PE·peGPCI
+ MP·mpGPCI) × CF

This code's Global fee

(6.52·1.000
+ 10.81·1.000
+ 1.68·1.000) × $33.40 = $634.95

Full methodology — how we apply CMS's rules →