How much does Medicare pay for CPT 19303?

Medicare allowed an average of $1046.29 per service and paid $833.05 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $4082.16, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 19303?

Simple complete removal of breast. It was billed 6,653 times to 6,547 Medicare beneficiaries by 423 providers in 2024.

Does 19303 pay differently in an office than a hospital?

Yes. The allowed amount averaged $913.98 in an office setting and $1051.22 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 19303 most?

General Surgery, with 4,235 services from 275 clinicians. Next are Surgical Oncology, Physician Assistant, Ambulatory Surgical Center.

CPT 19303

Simple complete removal of breast

$1046.29Medicare-allowed amount per service, averaged across 6,653 services

Providers submitted

$4082.16

Asking price, not received

Medicare allowed

$1046.29

The fee schedule figure

Medicare paid

$833.05

Balance is patient coinsurance

Providers submitted an average of $4082.16 for this code and Medicare allowed $1046.29 — 3.9× 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 $833.05 (80%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $913.98
Hospital / facility: $1051.22

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 239 services were billed in an office setting and 6,414 in a facility.

Services: 6,653
Beneficiaries: 6,547
Providers billing it: 423
Total allowed: $6,960,967

What Medicare pays for CPT 19303

Across 6,653 services billed by 423 providers to 6,547 beneficiaries, Medicare allowed an average of $1046.29 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 19303

Specialty	Services	Beneficiaries	Avg allowed	Providers
General Surgery	4,235	4,208	$1099.42	275
Surgical Oncology	1,448	1,442	$1098.67	91
Physician Assistant	438	436	$148.93	29
Ambulatory Surgical Center	280	209	$2018.15	12
Nurse Practitioner	201	201	$151.97	12
Thoracic Surgery	16	16	$1242.27	1
Internal Medicine	12	12	$989.56	1
Colorectal Surgery (Proctology)	12	12	$1308.34	1
Plastic and Reconstructive Surgery	11	11	$521.47	1

19303 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
Florida	777	$979.30	$679.93	46
Texas	503	$1127.99	$863.53	31
California	431	$1156.42	$813.95	29
Maryland	309	$1178.72	$797.35	21
Illinois	259	$1097.03	$741.45	18
Georgia	250	$1141.24	$876.44	18
New York	236	$1176.67	$682.59	16
Virginia	220	$1103.41	$847.36	15
Missouri	213	$971.90	$758.90	13
North Carolina	204	$1058.98	$874.52	13
Ohio	204	$996.18	$744.08	14
Tennessee	202	$979.54	$836.44	13
Oklahoma	198	$992.88	$799.93	10
Arkansas	191	$1158.19	$1007.85	10
Arizona	188	$1045.19	$816.89	11
Indiana	182	$1116.95	$937.78	10
Kansas	152	$697.46	$556.01	8
Pennsylvania	151	$1097.57	$803.30	11
Colorado	139	$1060.27	$788.07	10
Massachusetts	138	$971.58	$675.07	9
Louisiana	123	$1164.75	$891.99	7
Iowa	114	$1219.64	$1043.18	7
Washington	111	$1008.27	$754.66	7
South Dakota	108	$606.22	$499.55	6
New Jersey	97	$1149.67	$800.18	7
Kentucky	87	$942.94	$766.31	6
Mississippi	86	$899.97	$767.39	5
District of Columbia	86	$1246.76	$831.47	5
South Carolina	82	$1069.91	$814.69	6
Oregon	67	$1600.22	$1191.20	4
Wisconsin	61	$876.96	$669.20	5
Utah	60	$714.63	$559.97	3
New Hampshire	55	$807.22	$642.63	4
Minnesota	53	$802.50	$592.68	4
Nebraska	49	$731.54	$589.85	3
Michigan	39	$767.26	$532.54	3
Delaware	33	$1013.60	$786.46	2
Nevada	33	$1128.75	$831.38	2
Idaho	30	$934.79	$705.40	1
North Dakota	27	$1051.61	$884.47	2
Alabama	25	$566.25	$462.33	2
Maine	22	$559.08	$423.99	2
Montana	18	$907.12	$708.11	1
Alaska	17	$1119.51	$744.89	1
Rhode Island	12	$145.04	$86.89	1
Wyoming	11	$1149.78	$871.92	1

Related codes

19301Partial removal of breast$655.12

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.