Does 19282 require prior authorization?

No, 19282 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 19282?

Medicare facility rate: $41.42. Non-facility rate: $164.67. Work RVU: 0.98.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.98

Facility

$41.42

Non-Facility

$164.67

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.

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.
Radioactive seed localization of nonpalpable breast lesions is consideredmedically necessaryas a method to localize a nonpalpable breast lesion in advance of surgical excision.
Radioactive seed localization is consideredmedically necessaryto assist in targeted excision of positive axillary lymph nodes after neoadjuvant therapy.

A57848 — Billing and Coding: Tomosynthesis-Guided Breast Biopsy

ANTHEM-CG-SURG-58 — CG-SURG-58 Radioactive Seed Localization of Nonpalpable Breast Lesions

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