How much does Medicare pay for CPT 19125?

Medicare allowed an average of $580.83 per service and paid $459.00 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $2713.65, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 19125?

Removal of growth of breast identified by x-ray marker, first growth. It was billed 2,804 times to 2,783 Medicare beneficiaries by 171 providers in 2024.

Does 19125 pay differently in an office than a hospital?

Yes. The allowed amount averaged $457.60 in an office setting and $587.79 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 19125 most?

General Surgery, with 1,792 services from 112 clinicians. Next are Ambulatory Surgical Center, Surgical Oncology, General Practice.

CPT 19125

Removal of growth of breast identified by x-ray marker, first growth

$580.83Medicare-allowed amount per service, averaged across 2,804 services

Providers submitted

$2713.65

Asking price, not received

Medicare allowed

$580.83

The fee schedule figure

Medicare paid

$459.00

Balance is patient coinsurance

Providers submitted an average of $2713.65 for this code and Medicare allowed $580.83 — 4.7× 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 $459.00 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $457.60
Hospital / facility: $587.79

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 150 services were billed in an office setting and 2,654 in a facility.

Services: 2,804
Beneficiaries: 2,783
Providers billing it: 171
Total allowed: $1,628,647

What Medicare pays for CPT 19125

Across 2,804 services billed by 171 providers to 2,783 beneficiaries, Medicare allowed an average of $580.83 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 19125

Specialty	Services	Beneficiaries	Avg allowed	Providers
General Surgery	1,792	1,782	$427.12	112
Ambulatory Surgical Center	483	473	$1301.43	26
Surgical Oncology	483	482	$442.54	30
General Practice	17	17	$524.19	1
Colorectal Surgery (Proctology)	15	15	$440.01	1
Gynecological Oncology	14	14	$385.16	1

19125 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
New York	335	$634.24	$421.26	18
Florida	312	$468.76	$355.35	18
California	205	$630.43	$449.48	13
New Jersey	184	$808.92	$596.62	12
Massachusetts	181	$453.06	$343.89	11
Maryland	164	$621.39	$478.52	10
Mississippi	118	$529.47	$468.82	7
South Carolina	103	$409.78	$348.28	6
Virginia	101	$554.73	$437.68	6
Kentucky	93	$641.53	$528.96	6
Texas	89	$579.09	$465.80	5
Oregon	84	$786.43	$601.00	5
North Carolina	83	$631.00	$552.72	4
Illinois	77	$590.16	$437.59	5
Arkansas	64	$552.51	$498.63	4
Washington	61	$451.76	$346.93	4
Indiana	60	$594.19	$492.41	5
Missouri	50	$416.88	$338.55	4
Tennessee	47	$732.00	$695.96	2
Arizona	44	$371.49	$302.34	3
Nebraska	44	$957.03	$783.07	2
Iowa	43	$660.44	$565.82	2
Ohio	36	$387.59	$311.93	2
New Hampshire	36	$440.59	$348.20	2
Michigan	31	$914.42	$773.75	2
Georgia	24	$413.57	$322.05	2
District of Columbia	24	$448.99	$308.60	2
Oklahoma	23	$404.43	$352.44	2
Colorado	22	$803.29	$749.71	2
Louisiana	19	$291.93	$263.38	1
Kansas	13	$430.92	$370.10	1
Wisconsin	12	$412.81	$348.69	1
Nevada	11	$452.39	$354.83	1
Delaware	11	$414.09	$331.61	1

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.