Payer policies › CPT 1910019100 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 19100 Payer coverage policies that name 19100 19100 appears in 5 coverage policies from Aetna, Premera Blue Cross, UnitedHealthcare.
Payer Policy Role in policy Reviewed Document Aetna Breast Biopsy Procedures (0269) listed, no stance May 14, 2026 payer document Aetna Magnetic Resonance Imaging (MRI) of the Breast (0105) listed, no stance (range 19100-19101) Aug 6, 2026 payer document Aetna Skin and Soft Tissue Substitutes (0244) not covered (range 10040-19499) Jul 29, 2026 payer document Premera Blue Cross Preventive CareBreast cancer screening Ultrasound, mammography, and MRI covered if criteria are met Sep 21, 2026 payer document UnitedHealthcare Preventive Care Services (MP.016.59)Procedure Code(s): | No age limit. Requires one of the listed, no stance Jul 1, 2026 payer document
Medicaid fee-for-service AZ: $450.44 (asc), effective Oct 1, 2026 CO: $109.29 (chp_plus, non-facility), effective Jul 1, 2026 FL: $48.06 (physician, facility), effective Jan 1, 2026 IL: $59.60 (practitioner), effective Jul 1, 2026 IN: $51.20 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $450.00 (asc, facility), effective Aug 1, 1982 KY: $724.34 (asc), effective Jan 1, 2026 LA: $233.58 (asc), effective Jul 1, 2012 MA: $489.93 (asc), effective May 1, 2026 MS: $566.62 (comprehensive, facility), effective Oct 1, 2025 ND: $427.00 (physician, facility), effective Aug 1, 2026 NE: $413.00 (asc), effective Jul 1, 2024 NY: $60.60 (physician_surgery, facility), effective Jul 1, 2026 OH: $40.39 (physician, facility), effective Jan 1, 2024 OK: $660.83 (asc), effective Jan 1, 2026 TX: $486.45 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023 VA: $53.53 (medical, facility), effective Jul 1, 2026 VT: $1282.40 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $308.28 (asc), effective Jul 1, 2026 WY: $730.40 (outpatient_hospital_apc, Ambulatory Surgical Centers), effective Apr 1, 2026 From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.