CPT Code and Description
10030 – Image-Guided Fluid Collection Drainage By Catheter (Eg, Abscess, Hematoma, Seroma, Lymphocele, Cyst), Soft Tissue (Eg, Extremity, Abdominal Wall, Neck), Percutaneous.
10035 – Placement Of Soft Tissue Localization Device(S) (Eg, Clip, Metallic Pellet, Wire/Needle, Radioactive Seeds), Percutaneous, Including Imaging Guidance; First Lesion.
10036 – Placement Of Soft Tissue Localization Device(S) (Eg, Clip, Metallic Pellet, Wire/Needle, Radioactive Seeds), Percutaneous, Including Imaging Guidance; Each Additional Lesion (List Separately In Addition To Code For Primary Procedure).
Fee amount from Top Insurance:
| Insurance | CPT 10030 | CPT 10035 | CPT 10036 |
| Medicare | $590.27 | $337.39 | $278.29 |
| Aetna | $95.00-$105.00 | $104.50-$115.50 | $114.00-$126.00 |
| Anthem | $97.50-$102.50 | $107.25-$112.75 | $117.00-$123.00 |
| Blue Cross Blue Shield | $96.00-$104.00 | $105.60-$114.40 | $115.20-$124.80 |
| Cigna | $98.00-$103.00 | $108.50-$116.50 | $118.80-$127.20 |
| Humana | $96.50-$103.50 | $106.15-$113.85 | $115.80-$124.20 |
| Kaiser Permanente | $97.00-$103.00 | $107.00-$113.00 | $117.00-$123.00 |
| Medicaid | $95.00-$105.00 | $104.50-$115.50 | $114.00-$126.00 |
| UnitedHealthcare | $98.50-$103.50 | $108.25-$116.75 | $118.00-$127.00 |
| WellCare | $96.00-$104.00 | $105.60-$114.40 | $115.20-$124.80 |
Medicare Billing Guidelines for CPT 10030, 10035, and 10036:
- Max units: 1 per day
- Minimum Age: None
- Max Age: None
- NDC code required: No
- CLIA required: No
- Authorization required: No
- Referral required: No
- Allowed POS: All
- Not allowed POS: None
- Allowed TOS: All
BCBS Billing Guidelines for CPT 10030, 10035, and 10036:
- Max units: 1 per day
- Minimum Age: None
- Max Age: None
- NDC code required: No
- CLIA required: NO
- Authorization required: No
- Referral required: No
- Allowed POS: All
- Not allowed POS: None
- Allowed TOS: All
Integumentary System
- CPT code 10035
– For localization devices placed in soft tissue
– First lesion only
– Used only once per target regardless of how many are placed - CPT code 10036
– Is an add on code and should only be reported with 10035
– Is reported for each additional lesion that is localized
– This code is used to report an additional localization device whether on the same side or contralateral side but for a different lesion
Soft tissue is a‐generic term for muscle, fat, fibrous tissue, blood vessels, or other supporting tissue matrix
Use of CPT codes 10035 and 10036
Localization of wire options are:
Breast
intra-abdominal, intra-pelvic, retroperitoneum
Intra-thoracic
Prostate
Soft tissue
When inserted into soft tissue you will get code 10035 and 10036 for any additional lesions unless there is a more specific site descriptor for example: breast, intra-abd, intra-pelvic, retroperitoneum, intrathoracic, or prostate.
Patient had localization 2 wires placed in 1st lesion on the right and 1 wire placed in 2 different lesions on the left in the soft tissue of the groin with . What are your CPT codes?
10035-RT
10036-LT
10036-LT
