Mast mod rad

What is CPT Code 19307?

Modified radical mastectomy — surgical removal of the entire breast along with most axillary lymph nodes. Performed for breast cancer treatment. A major surgery typically requiring a 1–2 day hospital stay.

The Medicare reimbursement rate shown above is the amount the federal government has determined is a reasonable payment for this service. Hospitals and providers that participate in Medicare have agreed to accept these rates from Medicare patients.

Who typically bills this:Breast surgeon + hospital facility + anesthesiologist

Common Billing Errors for CPT 19307

• !Sentinel lymph node biopsy (38792 or 38900) billed separately when performed as part of the same mastectomy
• !Reconstruction codes billed at the same time without documentation that reconstruction was performed under the same anesthetic
• !Pathology for lymph nodes and breast tissue billed at inflated hospital lab rates

Red Flags on Your Bill

Negotiation Tips for CPT 19307

1. 1This is a global surgical package — post-operative care for 90 days is included in the surgeon's fee; dispute any additional surgeon office visits within that period
2. 2Request an itemized bill — implants, drains, and supplies should be itemized and are negotiable
3. 3The Women's Health and Cancer Rights Act requires insurers to cover reconstruction — confirm what your plan covers before surgery

Codes That Often Appear With This One

These CPT codes commonly appear on the same bill. Review each one to spot potential bundling errors or duplicate charges.

Found CPT 19307 on Your Bill?

If you see CPT code 19307 on a hospital or medical bill, compare the charged amount to the Medicare rate above. If your bill shows a significantly higher charge, you may have grounds to negotiate.

1. Note the amount charged for CPT 19307 on your itemized bill
2. Compare it to the Medicare rate above — calculate the markup
3. Call the billing department and use the Medicare rate as your anchor:“I see CPT code 19307 billed at [amount]. The Medicare rate for this procedure is $1,179.02. I'd like to discuss a fair adjustment.”