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CPT®
19294

CPT® Code 19294
Add-On Code

Official Description

Preparation of tumor cavity, with placement of a radiation therapy applicator for intraoperative radiation therapy (IORT) concurrent with partial mastectomy (List separately in addition to code for primary procedure)

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

The CPT® Code 19294 refers to the preparation of the tumor cavity with the placement of a radiation therapy applicator specifically for intraoperative radiation therapy (IORT) that is performed concurrently with a partial mastectomy. This procedure is a critical component of breast conservation therapy (BCT), which aims to remove malignant breast tumors while preserving as much healthy tissue as possible. During IORT, a targeted dose of radiation is delivered directly to the tumor bed immediately after the tumor is excised. This approach is designed to eliminate any microscopic residual tumor cells that may remain in the area, thereby reducing the risk of local recurrence of breast cancer. The procedure involves careful preparation of the tumor cavity, which includes separating the remaining breast tissue from the underlying pectoralis muscle and the skin. A protective disc is then placed beneath the breast tissue to shield vital organs such as the heart, lungs, and ribs from radiation exposure. Following this preparation, a radiation applicator tube is inserted into the tumor bed to facilitate the delivery of the radiation dose. Once the IORT is completed, both the applicator tube and the protective disc are removed. It is important to note that CPT® Code 19294 is reported separately in addition to the code(s) for the primary procedure(s) performed, such as the partial mastectomy, ensuring accurate billing and documentation of the services rendered.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The procedure associated with CPT® Code 19294 is indicated for patients undergoing breast conservation therapy (BCT) when a malignant breast tumor is present. The specific indications for performing intraoperative radiation therapy (IORT) concurrent with a partial mastectomy include:

  • Malignant Breast Tumor The presence of a malignant tumor in the breast that necessitates surgical intervention, such as a lumpectomy or partial mastectomy.
  • Breast Conservation Therapy The desire to preserve as much healthy breast tissue as possible while effectively treating the cancer.
  • Microscopic Residual Tumor Cells The need to target and destroy any remaining microscopic tumor cells in the tumor bed after surgical excision.

2. Procedure

The procedure for CPT® Code 19294 involves several critical steps to ensure the effective delivery of intraoperative radiation therapy (IORT) during a partial mastectomy. The steps are as follows:

  • Step 1: Tumor Excision The surgical team begins by excising the breast tumor along with a margin of surrounding healthy tissue. This is typically performed through a partial mastectomy, which aims to remove the tumor while conserving as much breast tissue as possible.
  • Step 2: Tumor Cavity Preparation After the tumor is removed, the next step involves preparing the tumor cavity. This is done by carefully separating the remaining breast tissue from the underlying pectoralis muscle and the skin to create a clear space for the radiation therapy applicator.
  • Step 3: Insertion of Protective Disc A protective disc is then inserted beneath the breast tissue. This disc serves as a shield to protect vital organs, including the heart, lungs, and ribs, from radiation exposure during the IORT procedure.
  • Step 4: Placement of Radiation Applicator Following the placement of the protective disc, a radiation applicator tube is inserted into the tumor bed. This applicator is essential for delivering the radiation dose directly to the area where the tumor was located.
  • Step 5: Delivery of Intraoperative Radiation Therapy The IORT is then performed, delivering a single, targeted dose of radiation to the tumor bed. This step is crucial for destroying any remaining microscopic tumor cells and minimizing the risk of local recurrence.
  • Step 6: Removal of Applicator and Disc Once the IORT is completed, the radiation applicator tube and the protective disc are carefully removed from the surgical site, concluding the procedure.

3. Post-Procedure

After the completion of the procedure associated with CPT® Code 19294, patients may require specific post-procedure care to ensure proper recovery. This may include monitoring for any immediate complications related to the surgery or radiation therapy. Patients are typically advised to follow up with their healthcare provider for ongoing assessments and to discuss any further treatment options, such as adjuvant therapies. Additionally, patients may experience localized swelling or discomfort in the breast area, which should be managed according to the physician's recommendations. It is essential for patients to adhere to any prescribed follow-up appointments to monitor their recovery and overall health following the procedure.
Short Descr PREPJ TUM CAV IORT PRTL MAST
Medium Descr PREPJ TUMOR CAVITY IORT W/PARTIAL MASTECTOMY
Long Descr Preparation of tumor cavity, with placement of a radiation therapy applicator for intraoperative radiation therapy (IORT) concurrent with partial mastectomy (List separately in addition to code for primary procedure)
Status Code Active Code
Global Days ZZZ - Code Related to Another Service
PC/TC Indicator (26, TC) 0 - Physician Service Code
Multiple Procedures (51) 0 - No payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50) 0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 0 - Payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62) 0 - Co-surgeons not permitted for this procedure.
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Items and Services Packaged into APC Rates
ASC Payment Indicator Packaged service/item; no separate payment made.
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) none
MUE 2

This is an add-on code that must be used in conjunction with one of these primary codes.

19301 MPFS Status: Active Code APC J1 ASC A2 Physician Quality Reporting CPT Assistant Article Illustration for Code Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy);
19302 MPFS Status: Active Code APC J1 ASC A2 Physician Quality Reporting CPT Assistant Article Illustration for Code Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy); with axillary lymphadenectomy
59 Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
LT Left side (used to identify procedures performed on the left side of the body)
AS Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
RT Right side (used to identify procedures performed on the right side of the body)
80 Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s).
82 Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s).
GC This service has been performed in part by a resident under the direction of a teaching physician
Date
Action
Notes
2023-01-01 Note Short and medium descriptions changed.
2018-01-01 Added Code Added.
Code
Description