Excise breast duct fistula
Breast duct fistula removal costs range from $333 to $3,829 depending on your facility type, with potential differences of $3,496 making bill verification essential.
About the analyst
David Park researches procedure pricing and insurance reimbursement patterns at BillRazor Research. He specializes in cost comparison across care settings and metropolitan areas. Expertise: procedure pricing, insurance reimbursement, cost comparison.
Code 19112 covers surgical removal of an abnormal connection between a breast duct and the skin surface, typically performed on women with recurrent breast infections or chronic drainage. This outpatient procedure is commonly billed by general surgeons and requires documentation of the fistula's location and complexity. Medicare reimbursement averages $1,245, with facility fees creating potential differences of $2,800 depending on whether the procedure occurs in a hospital outpatient department versus ambulatory surgery center.
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Facility rate
$333
National Medicare benchmark
Non-facility rate
$99
Office setting benchmark
Data sources
4
24 data points
Key insights for CPT 19112
ASC vs hospital outpatient savings
$2,291Having this done at an ambulatory surgery center costs $1,538 vs $3,829 at a hospital outpatient
Facility vs office setting
$234 differenceNon-facility setting is less expensive for this procedure
What this procedure costs across different settings
The same procedure can cost very different amounts depending on where it's performed. These are the Medicare-allowed amounts — what hospitals actually charge can be 3-10x higher.
| Setting | Medicare rate | vs lowest |
|---|---|---|
| Facility (physician office) | $333 | +236% |
| Non-facility (office) | $99 | Lowest |
| Outpatient (APC) | $3,829 | +3768% |
| Ambulatory surgery (ASC) | $1,538 | +1454% |
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About this data
Rates shown are from the 2026 Medicare Physician Fee Schedule, Hospital Outpatient Prospective Payment System (OPPS), Ambulatory Surgery Center Payment System, Clinical Laboratory Fee Schedule, Durable Medical Equipment Fee Schedule, and CMS Inpatient Prospective Payment System (DRG weights). Regional adjustments use CMS Geographic Practice Cost Indices (GPCI). Hospital charges are from CMS Hospital Price Transparency machine-readable files. All data is publicly available under federal law (45 CFR Part 180).
This data is for informational purposes only and does not constitute medical or financial advice. Actual costs depend on insurance coverage, negotiated rates, and individual circumstances.
Data: Medicare Physician Fee Schedule, CMS Inpatient PPS (IPPS), Outpatient PPS (OPPS), ASC Payment System, Clinical Lab Fee Schedule (CLFS), National Average Drug Acquisition Cost (NADAC). FY 2024 data. All publicly available from CMS.
Methodology: Facility rate applies when the procedure is performed in a hospital or ASC. Non-facility rate applies in a physician office. GPCI adjustments reflect regional cost-of-living differences.
This information is for educational purposes only and is not medical, financial, or legal advice. Actual costs depend on your insurance and provider. We recommend verifying costs directly with your provider. Full methodology · Terms of use