19083
Breast Biopsy
Our Work > Good Faith Estimates > Breast Biopsy
Recent regulations require hospitals and health plans to publish prices of a subset of services. The hospital rule requires publication of “shoppable services,” those that can be scheduled in advance by a consumer. The Transparency in Coverage rule requires a list of 500 items and services to be published. Breast biopsy appears on both lists, and there is a standard service package available for it.
A breast biopsy is a procedure to remove a sample of breast tissue for testing. The tissue sample is sent to a lab, where doctors who specialize in analyzing blood and body tissue examine the tissue sample and provide a diagnosis. A breast biopsy might be recommended if you have a suspicious area in your breast, such as a breast lump or other signs and symptoms of breast cancer. It can also be used to investigate unusual findings on a mammogram, ultrasound or other breast exam. The results of a breast biopsy can show whether the area in question is breast cancer or if it’s not cancerous. The procedure can help your doctor determine whether you need additional surgery or other treatment.
Your service utilization may vary from this service package for a number of reasons, including your unique clinical profile and where you receive your services. Additional pathology may be required and is included in this service package as an optional fee.
This Service Package was generated using outpatient care setting claims. However, this service package may also be performed in the below care settings. Please confirm with your provider in which care setting you will receive services, as this may affect your cost.
- Inpatient: Discuss with your provider
- Outpatient facility: 99%
Item Definitions
Index
Index
this is the fee for the service being defined; note that other codes may be used to define a similar service
Facility Fee
Facility Fee
these fees are most commonly associated with the index event; these may also be
paid to the facility in addition to the index fee
Professional Fee
Professional Fee
these fees are paid to clinicians for the work associated with this service
Optional Fee
Optional Fee
these services are often also billed with the index event, however may vary based on the patient’s individual circumstances
Ancillary Service
Ancillary Service
these are supply codes that identify other services that may be billed with the index event
Proposed Technical Definition
| association | base_code | code_type | estimated_charge | id | item_type | modifier | name |
|---|---|---|---|---|---|---|---|
| professional_f | J1 | Breast Biopsy | |||||
| 1 | 19083 | CPT | 2156.64 | 15096 | ee | ||
| 1 | 19083 | CPT | 7070.87 | 14142 | index | Breast Biopsy | |
| 0.901223776 | 88305 | CPT | 3162.65 | 14143 | facility_fee | Surgical Pathology Level 4 | |
| 0.845 | 88305 | CPT | 355.86 | 15097 | professional_fee | Q1 | Surgical Pathology Level 4 |
| 0.723 | 77065 | CPT | 264.18 | 15098 | professional_fee | A | Mammography, diagnostic |
| 0.632867133 | 77065 | CPT | 3914.61 | 14144 | facility_fee | Mammography, diagnostic | |
| 0.627 | 88360 | CPT | 888.94 | 15099 | professional_fee | Q2 | Morphometric analysis, tumor immunohistochemistry (eg, Her-2/neu, estrogen receptor/progesterone receptor), quantitative or semiquantitative, per spec |
| 0.491258741 | A4648 | HCPCS | 3488.28 | 14146 | facility_fee | Implantable Tissue Marker | |
| 0.472902098 | 272 | Revenue Code | 14147 | ancillary_service | Sterile supplies | ||
| 0.317016317 | 250 | Revenue Code | 338.43 | 14148 | ancillary_service | Pharmacy | |
| 88342 | $130 | optional_fee [facility] | |||||
| 88342 | $60 | optional_fee [professional] |
Captured Spending (N=10,000)
| Decile | Base Fee (Facility + Professional) | Base Fee + Optional Fees |
| 1 | 2% | 1% |
| 2 | 1% | 1% |
| 3 | 3% | 1% |
| 4 | 5% | 3% |
| 5 | 6% | 4% |
| 6 | 9% | 6% |
| 7 | 13% | 10% |
| 8 | 15% | 13% |
| 9 | 14% | 14% |
| 10 | 32% | 48% |
Our Work > Good Faith Estimates > Breast Biopsy