Does 19281 require prior authorization?

No, 19281 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 19281?

Medicare facility rate: $83.17. Non-facility rate: $234.81. Work RVU: 1.95.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

1.95

Facility

$83.17

Non-Facility

$234.81

For tomosynthesis-only procedures billed with CPT 19499, document the name of the procedure in the claim comments/narrative field: Part B — Loop 2400 SV101-7 for 837P (Item 19 for paper claims); Part A — Line SV202-7 for 837I electronic claims and Block 80 on the UB04 form.
Procedure notes must clearly document additional lesion(s) biopsied and specify which breast for each additional 19499 coded with modifier -59 or modifier -50.
If a different imaging modality is used during the same date of service, documentation must clearly support the clinical necessity to switch imaging modalities when modifier -59 is appended to the additional imaging CPT code.
Retain and provide copies of hard-copy output with analysis of all data (including bidirectional vascular flow or imaging when provided) in the patient record.

When digital breast tomosynthesis is the only imaging guidance used for a percutaneous core needle breast biopsy, bill CPT 19499 (Unlisted procedure, breast) and document the procedure name in the claim comments/narrative.
When tomosynthesis-only guidance is used to place a breast localization device (without biopsy), bill CPT 19499 with a clear description in the comments/narrative for Part A and Part B claims.
If a percutaneous breast biopsy is performed using both stereotactic and tomosynthesis imaging guidance, bill CPT 19081 for the first lesion (stereotactic guidance).
If more than one lesion is biopsied with tomosynthesis-only guidance on the same date of service, code an additional 19499 with modifier -59 for additional lesion(s) on the same breast, or use modifier -50 to indicate a bilateral procedure for lesions on the opposite breast.
Perform peripheral venous ultrasound to evaluate clinical signs or symptoms suggestive of acute or new-onset deep vein thrombosis (e.g., extremity swelling, tenderness, erythema).
Perform venous ultrasound to investigate DVT as the source of a confirmed pulmonary embolism.

L33693 — Peripheral Venous Ultrasound

J09

A53252 — Billing and Coding: Independent Diagnostic Testing Facility (IDTF)

J12

L37371 — Electroretinography (ERG)

J12

L35007 — Vestibular and Audiologic Function Studies

J12

L35434 — Oximetry Services

Ask Verity about documentation requirements, denial risks, or coverage in your state.