CPT 19120 is the surgical removal of a breast lump, cyst or other mass through an incision, with the tissue sent to pathology. It is an outpatient operation under general or local anesthesia, taking about an hour, and is used when a needle biopsy is not possible or when the whole lump needs to come out.
What the price covers
The hospital's price is the facility fee for the operating room, nursing, supplies and recovery. The surgeon, the anesthesia provider and the pathologist bill separately. Pre-operative imaging and any wire or seed placed to locate the lump are separate charges.
Why prices vary
Outpatient breast surgery prices span several times within one metro area. Ambulatory surgery centers, which do not publish these files, are often considerably cheaper than hospital outpatient departments for the same operation. Large systems and academic centers list the highest charges.
Questions to ask
- What is the self-pay price for 19120, and what do surgeon, anesthesia and pathology add?
- Is localization (wire or seed) needed, and what does it cost?
- Can the surgeon do it at an ambulatory surgery center?