CPT code 11980: Hormone pellets, subcutaneous implantation2026 Medicare rate & RVUs in New Jersey
Report this service when a clinician places hormone pellets beneath the skin, commonly for pellet-based hormone therapy such as testosterone replacement.
Medicare pays $103.58–$108.05 for 11980 in the office in New Jersey, from Rest of New Jersey to Northern New Jersey. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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What 11980 covers
A clinician places one or more hormone pellets into subcutaneous tissue through a small incision or insertion site. This is commonly performed in an office by clinicians providing hormone therapy, including gynecologists, urologists, endocrinologists, and other qualified providers. The upper buttock or hip region is a typical site. The pellets provide a sustained hormone source after placement; this code represents the implantation procedure, not a skin injection or insertion of a contraceptive capsule.
Report the service for the implantation encounter, documenting the hormone product, number of pellets, insertion site, and procedure performed. The code describes pellet implantation rather than a separate unit for each pellet. It has a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and the others are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery, and co-surgeons and team surgery are not permitted.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 11980 pays more and less in New Jersey
| Payment locality | Office | Facility |
|---|---|---|
| Northern New Jersey | $108.05 | $52.25 |
| Rest of New Jersey | $103.58 | $51.05 |
How the 11980 rate is calculated
Each of 11980’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 11980
RVUs × geographic indexes × conversion factor
Work1.07
1.07 RVUs× 1.000 GPCI
Practice expense1.67
1.67 RVUs× 1.000 GPCI
Malpractice0.15
0.15 RVUs× 1.000 GPCI
Adjusted RVUs
2.8900
Conversion factor
$33.4009
Medicare rate
$96.53
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 11980
The CMS indicators that decide how 11980 is paid alongside other services.
CMS payment indicators · 11980
Hormone pellets, subcutaneous implantation
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
11980 without 51 · national office
$96.53
Hormone pellets, subcutaneous implantation
11980-51 · Second procedure: 50%
$48.27
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
11980 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 11981Drug implant insertionNon-biodegradable implant
- Choose 11980 for hormone pellets. Code 11981 is for insertion of a drug-delivery implant, such as an implant device used to deliver medication.
- 11983Drug implantRemoval with replacement
- Code 11983 describes removal and reinsertion of a drug implant during the encounter. It is not the code for placing hormone pellets.
- 11976Contraceptive implant removalRemoval only
- Code 11976 is for removing a contraceptive capsule. It describes removal of that implant, not placement of hormone pellets.
11980 billing questions
How is this different from 11981?
Use 11980 for hormone pellet implantation. Code 11981 describes insertion of a drug-delivery implant and is not the hormone-pellet code.
Should units be reported for each pellet?
The service is the implantation procedure; the code is not reported as one unit per pellet. Document the number of pellets placed.
Does the 0-day global period include same-day follow-up care?
Same-day preoperative and postoperative care is included in the procedure's 0-day global period.
Can modifier 50 be used for pellets placed on both sides?
No. The CMS bilateral adjustment does not apply to this code, and modifier 50 is inappropriate.
Can an assistant surgeon or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this service. Co-surgeons and team surgery are not permitted.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
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