How much does Medicare pay for CPT 19081?

Medicare allowed an average of $288.07 per service and paid $222.93 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1846.33, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 19081?

Biopsy of breast and placement of locating device using x-ray with needle, first growth. It was billed 31,067 times to 30,794 Medicare beneficiaries by 1,609 providers in 2024.

Does 19081 pay differently in an office than a hospital?

Yes. The allowed amount averaged $425.63 in an office setting and $164.51 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 19081 most?

Diagnostic Radiology, with 28,695 services from 1,499 clinicians. Next are General Surgery, Independent Diagnostic Testing Facility (IDTF), Ambulatory Surgical Center.

CPT 19081

Biopsy of breast and placement of locating device using x-ray with needle, first growth

$288.07Medicare-allowed amount per service, averaged across 31,067 services

Providers submitted

$1846.33

Asking price, not received

Medicare allowed

$288.07

The fee schedule figure

Medicare paid

$222.93

Balance is patient coinsurance

Providers submitted an average of $1846.33 for this code and Medicare allowed $288.07 — 6.4× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $222.93 (77%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $425.63
Hospital / facility: $164.51

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 14,701 services were billed in an office setting and 16,366 in a facility.

Services: 31,067
Beneficiaries: 30,794
Providers billing it: 1,609
Total allowed: $8,949,471

What Medicare pays for CPT 19081

Across 31,067 services billed by 1,609 providers to 30,794 beneficiaries, Medicare allowed an average of $288.07 per service. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 19081

Specialty	Services	Beneficiaries	Avg allowed	Providers
Diagnostic Radiology	28,695	28,449	$283.21	1,499
General Surgery	1,322	1,312	$301.36	71
Independent Diagnostic Testing Facility (IDTF)	347	343	$470.58	10
Ambulatory Surgical Center	216	208	$617.99	3
Interventional Radiology	191	189	$246.71	11
Surgical Oncology	118	117	$207.03	6
Family Practice	50	48	$478.56	2
Radiation Oncology	45	45	$151.22	2
Nuclear Medicine	30	30	$154.60	2
Pediatric Medicine	29	29	$445.95	1
Obstetrics & Gynecology	12	12	$457.41	1
Dermatology	12	12	$184.46	1

19081 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
California	2,763	$310.32	$217.80	144
New York	2,660	$390.96	$264.36	130
Florida	2,650	$309.75	$243.39	124
North Carolina	1,619	$329.76	$268.40	86
Texas	1,508	$252.29	$198.65	91
New Jersey	1,370	$343.96	$243.14	66
Pennsylvania	1,351	$228.99	$172.52	75
Virginia	1,337	$293.65	$227.64	68
Massachusetts	1,172	$186.33	$135.75	64
Maryland	1,168	$477.88	$350.47	47
Illinois	1,166	$200.99	$149.44	65
Ohio	953	$185.64	$139.32	57
Indiana	783	$200.55	$158.37	36
Washington	718	$342.26	$258.94	39
Missouri	697	$171.00	$129.71	37
Michigan	645	$216.07	$161.98	41
Georgia	636	$224.13	$172.75	35
South Carolina	630	$170.66	$139.80	33
Arizona	604	$443.01	$355.01	29
Kentucky	473	$191.94	$154.50	24
Tennessee	457	$290.09	$240.22	24
Arkansas	443	$300.18	$260.07	22
District of Columbia	377	$381.84	$261.11	15
Colorado	374	$353.75	$269.71	17
Louisiana	346	$164.06	$129.89	21
Connecticut	331	$275.97	$197.24	21
Nebraska	291	$391.02	$324.16	8
Iowa	290	$314.35	$259.65	13
Rhode Island	274	$253.88	$185.79	15
Oregon	271	$390.70	$314.24	13
Delaware	256	$289.98	$220.02	10
Oklahoma	240	$150.00	$119.07	15
Wisconsin	214	$244.38	$199.10	12
Alabama	195	$145.98	$119.66	10
Minnesota	193	$262.02	$208.50	11
South Dakota	177	$182.64	$141.74	8
Nevada	144	$342.13	$263.09	7
Kansas	144	$281.91	$233.36	9
New Hampshire	134	$157.58	$117.04	7
Mississippi	132	$245.15	$211.69	8
Maine	112	$159.27	$114.30	5
Vermont	111	$152.39	$118.12	8
Wyoming	104	$366.13	$307.98	5
West Virginia	86	$156.66	$118.61	5
Utah	75	$152.53	$119.83	5
North Dakota	73	$207.48	$172.05	5
Idaho	61	$149.49	$120.34	4
Hawaii	59	$275.51	$217.60	3
New Mexico	53	$447.83	$378.69	4
Montana	50	$153.28	$114.88	3
Alaska	49	$318.02	$197.41	2
AP	32	$167.04	$113.55	2
Guam	16	$502.27	$392.42	1

Related codes

19083Biopsy of breast and placement of locating device$269.45
19085Biopsy of breast and placement of locating device$425.90

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.