Percutaneous Image-Guided Breast Biopsy
Percutaneous image-guided breast biopsy is a method of obtaining a breast biopsy through a percutaneous incision by employing image guidance systems. Image guidance systems may be either ultrasound or stereotactic.
For services furnished on or after January 1, 2003, Medicare will cover percutaneous image-guided breast biopsy using stereotactic or ultrasound imaging for the following breast lesions:
- Nonpalpable Breast Lesions
These lesions are covered for a radiographic abnormality that is nonpalpable and is graded as a Breast Imaging Reporting and Data System (BIRADS) III (probably benign), IV (suspicious abnormality), or V (abnormality).
- Palpable Breast Lesions
Coverage also includes palpable lesions that are difficult to biopsy using palpation alone. Carriers and intermediaries may decide the types of palpable lesions difficult to biopsy using palpation.
In the absence of national frequency limitations, carriers and intermediaries may also develop reasonable frequency limitations.
Applicable CPT Codes for Percutaneous Image-Guided Breast Biopsy
19102 percutaneous needle core, using imaging guidance
19103 percutaneous automated vacuum assisted or rotating biopsy device, using imaging guidance
10022 fine needle aspiration; with imaging guidance
NOTE: For imagining guidance performed in conjunction with 19102 and 19103, see codes 76095, 76096, 76360, 76393 and 76942.
Payment and pricing information will be included in the January update of the Medicare Physician Fee Schedule Database (MPFSDB). Deductible and coinsurance apply. The Medicare limiting charge applies when physicians or other practitioners do not accept assignment.
The remittance notice will identify claims denied because the service was performed prior to January 1, 2003.
Page Last Updated: Monday, 09-Jun-2008 13:34:26 CDT
