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CPT code 11981: Drug implant insertion, non-biodegradable implant2026 Medicare rate & RVUs in Queens, NY

Report 11981 for inserting a non-biodegradable drug delivery implant, such as a subdermal contraceptive implant placed in the upper arm.

CMS RVU26DEffective Oct 1, 2026One payment locality8.6K Medicare services in 2024

In Queens, NY, Medicare pays $124.57 for 11981 in the office and $62.20 when it’s performed in a hospital or facility.

$124.57Office (non-facility)
$62.20Hospital or facility
+15.8%vs the national office rate ($107.55)

Check a contract rate as a % of Medicare · 11981 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

We’ll open 11981 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Queens, NY
  2. What 11981 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

What 11981 covers

Code 11981 describes the procedure to place a non-biodegradable implant that releases medication over time. A common example is insertion of an etonogestrel contraceptive implant beneath the skin of the upper arm. The service is typically performed in an office or other outpatient setting by a physician or other qualified clinician. The implant product is distinct from the insertion procedure; for an etonogestrel contraceptive implant, the product may be reported with HCPCS code J7307 when applicable.

Report the insertion when the implant is placed, and document the medication or implant, insertion site, and completed procedure. This is a minor procedure with a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate for this service. Assistant-at-surgery payment requires documentation of medical necessity; 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.

How Queens, NY compares for 11981

Across 109 of 109 payment localities, the office rate for 11981 runs from $95.20 in Arkansas to $136.42 in San Benito County, CA. Queens, NY pays $124.57. The RVUs are the same everywhere; the geographic indexes change the dollars.

11981 in Queens, NY vs other payment areas
  1. Queens, NY · this page$124.57
  2. Manhattan, NY · New York$124.31−$0.26
  3. NYC suburbs and Long Island, NY · New York$127.93+$3.36
  4. Poughkeepsie and northern NYC suburbs, NY · New York$116.72−$7.85
  5. Rest of New York · New York$102.29−$22.28
  6. Los Angeles, CA · California$118.33−$6.24
  7. Washington, DC area · District of Columbia$121.64−$2.93

Other areas in New York first, then benchmark localities. Bars start at $0.

Every other payment area

11981 in every other Medicare payment locality
Payment localityOfficeFacility
Miami, FLFlorida$120.88$65.94
Chicago, ILIllinois$117.21$64.17
AlaskaAlaska$127.06$70.86
AlabamaAlabama$96.57$50.40
ArkansasArkansas$95.20$49.87
ArizonaArizona$104.57$53.44
Bakersfield, CACalifornia$111.61$53.77
Chico, CACalifornia$111.02$53.18

11981 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$95.20

$127.06

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
11981 office rate range by state
State / territoryOffice rate rangeLocalities
AK$127.061
AL$96.571
AR$95.201
AZ$104.571
CA$111.02–$136.4229
CO$110.521
CT$114.651
DC$121.641
DE$106.271
FL$108.29–$120.883
GA$102.04–$110.092
GU$113.291
HI$113.291
IA$97.931
ID$98.781
IL$105.98–$117.214
IN$99.311
KS$97.981
KY$99.911
LA$99.96–$104.762
MA$110.08–$120.612
MD$108.11–$121.643
ME$99.82–$104.392
MI$102.93–$110.142
MN$104.451
MO$98.61–$104.523
MS$96.901
MT$107.541
NC$100.771
ND$103.381
NE$98.301
NH$109.281
NJ$115.55–$120.522
NM$103.691
NV$106.441
NY$102.29–$127.935
OH$102.091
OK$99.201
OR$105.21–$113.392
PA$101.96–$112.172
PR$108.141
RI$109.591
SC$101.681
SD$102.891
TN$98.531
TX$101.34–$110.518
UT$103.031
VA$104.41–$121.642
VI$108.141
VT$103.451
WA$109.72–$122.532
WI$100.031
WV$102.261
WY$105.731

See 11981 in every payment locality

How the 11981 rate is calculated

Each of 11981’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 · 11981

RVUs × geographic indexes × conversion factor

Office or facility?

Work1.11

1.11 RVUs× 1.000 GPCI

Practice expense1.90

1.90 RVUs× 1.000 GPCI

Malpractice0.21

0.21 RVUs× 1.000 GPCI

Adjusted RVUs

3.2200

Conversion factor

$33.4009

Medicare rate

$107.55

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Queens, NY inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

1,393

Code
11981
Physician work
1.11
Practice expense
1.90
Malpractice
0.21

GPCI2026.csv

81

Locality
Queens, NY
Physician work
1.064
Practice expense
1.182
Malpractice
1.442
Office calculation for 11981 in Queens, NY
ComponentRVULocality factorAdjusted
Physician work1.11× 1.0641.1810
Practice expense1.90× 1.1822.2458
Malpractice0.21× 1.4420.3028
Total RVUs3.7297
Conversion factor× 33.4009

Office rate, Queens, NY$124.57

Office: (1.11 × 1.064 + 1.9 × 1.182 + 0.21 × 1.442) × $33.4009 = $124.57

Facility: (1.11 × 1.064 + 0.32 × 1.182 + 0.21 × 1.442) × $33.4009 = $62.20

Open 11981 in the RVU calculator

Payment rules and modifiers for 11981

The CMS indicators that decide how 11981 is paid alongside other services.

CMS payment indicators · 11981

Drug implant insertion, non-biodegradable implant

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)0Not paid without supporting documentation.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

11981 without 51 · national office

$107.55

Drug implant insertion, non-biodegradable implant

11981-51 · Second procedure: 50%

$53.78

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%).

When to use modifier 51

Codes related to 11981

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 11981
CodeHow it relatesOffice range, Queens, NY
Often billed with
J7307Etonogestrel implant, implant and suppliesReports the etonogestrel contraceptive implant product when applicable with its insertion.No office rate
Same family
11980Hormone pellets, subcutaneous implantationInsertion code for hormone pellets rather than a non-biodegradable drug delivery implant.$111.18
11982Implant removal, removal onlyRemoval procedure for a drug implant device.$132.25
11983Drug implant, removal with replacementRemoval and reinsertion of a drug implant device.$166.57

How 11981 has changed in Queens, NY

11981 · Office / nonfacility

$124.57

Effective 2026-10-01

The base rate is $10.43 higher than on 2025-10-01, moving from $114.14 to $124.57 (9.1%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $114.14changed to$124.57

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.14 changed to 1.11
    • Practice expense RVU 1.68 changed to 1.90
    • Work GPCI 1.065 changed to 1.064
    • Practice expense GPCI 1.195 changed to 1.182
    • Malpractice GPCI 1.462 changed to 1.442

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $117.46changed to$114.14

    • Conversion factor 33.2875 changed to 32.3465

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $115.55changed to$117.46

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $123.55changed to$115.55

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 1.67 changed to 1.68
    • Malpractice RVU 0.20 changed to 0.21
    • Work GPCI 1.061 changed to 1.065
    • Practice expense GPCI 1.212 changed to 1.195
    • Malpractice GPCI 2.061 changed to 1.462

  5. January 1, 2023

    RVU23A

    $132.04changed to$123.55

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 1.65 changed to 1.67
    • Malpractice RVU 0.22 changed to 0.20
    • Work GPCI 1.056 changed to 1.061
    • Practice expense GPCI 1.228 changed to 1.212
    • Malpractice GPCI 2.661 changed to 2.061

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $134.35changed to$132.04

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 1.70 changed to 1.65
    • Malpractice RVU 0.21 changed to 0.22

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $132.45changed to$134.35

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 1.60 changed to 1.70
    • Malpractice RVU 0.22 changed to 0.21
    • Work GPCI 1.054 changed to 1.056
    • Practice expense GPCI 1.214 changed to 1.228
    • Malpractice GPCI 2.391 changed to 2.661

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $175.89changed to$132.45

    • Conversion factor 36.0391 changed to 36.0896
    • Work RVU 1.48 changed to 1.14
    • Practice expense RVU 2.31 changed to 1.60
    • Malpractice RVU 0.26 changed to 0.22
    • Work GPCI 1.052 changed to 1.054
    • Practice expense GPCI 1.200 changed to 1.214
    • Malpractice GPCI 2.121 changed to 2.391

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $175.69changed to$175.89

    • Conversion factor 35.9996 changed to 36.0391

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $173.71changed to$175.69

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 2.27 changed to 2.31
    • Malpractice GPCI 2.151 changed to 2.121

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $172.21changed to$173.71

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 2.24 changed to 2.27
    • Practice expense GPCI 1.199 changed to 1.200
    • Malpractice GPCI 2.181 changed to 2.151

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $174.48changed to$172.21

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 2.26 changed to 2.24
    • Malpractice RVU 0.27 changed to 0.26

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $173.61changed to$174.48

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $163.79changed to$173.61

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 2.16 changed to 2.26
    • Malpractice RVU 0.23 changed to 0.27
    • Work GPCI 1.057 changed to 1.052
    • Practice expense GPCI 1.197 changed to 1.199
    • Malpractice GPCI 1.836 changed to 2.181

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $161.20changed to$163.79

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 2.35 changed to 2.16
    • Malpractice RVU 0.24 changed to 0.23
    • Work GPCI 1.062 changed to 1.057
    • Practice expense GPCI 1.195 changed to 1.197
    • Malpractice GPCI 1.491 changed to 1.836

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $161.20

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$124.57$62.20RVU26D
2026-07-01$124.57$62.20RVU26C
2026-04-01$124.57$62.20RVU26B
2026-01-01$124.57$62.20RVU26A
2025-10-01$114.14$70.08RVU25D
2025-07-01$114.14$70.08RVU25C
2025-04-01$114.14$70.08RVU25B
2025-01-01$114.14$70.08RVU25A
2024-10-01$117.46$71.32RVU24D
2024-07-01$117.46$71.32RVU24C
2024-04-01$117.46$71.32RVU24B
2024-03-09$117.46$71.32RVU24AR
2024-01-01$115.55$70.16RVU24A
2023-10-01$123.55$76.31RVU23D
2023-07-01$123.55$76.31RVU23C
2023-04-01$123.55$76.31RVU23B
2023-01-01$123.55$76.31RVU23A
2022-10-01$132.04$83.59RVU22D
2022-07-01$132.04$83.59RVU22C
2022-04-01$132.04$83.59RVU22B
2022-01-01$132.04$83.59RVU22A
2021-10-01$134.35$83.79RVU21D
2021-07-01$134.35$83.79RVU21C
2021-04-01$134.35$83.79RVU21B
2021-01-01$134.35$83.79RVU21A
2020-10-01$132.45$84.25RVU20D
2020-07-01$132.45$84.25RVU20C
2020-04-01$132.45$84.25RVU20B
2020-01-01$132.45$84.25RVU20A
2019-10-01$175.89$104.53RVU19D
2019-07-01$175.89$104.53RVU19C
2019-04-01$175.89$104.53RVU19B
2019-01-01$175.89$104.53RVU19A
2018-10-01$175.69$104.41RVU18D
2018-07-01$175.69$104.41RVU18C
2018-04-01$175.69$104.41RVU18B
2018-01-01$175.69$104.41RVU18AR1
2017-10-01$173.71$103.94RVU17D
2017-07-01$173.71$103.94RVU17C
2017-04-01$173.71$103.94RVU17B
2017-01-01$173.71$103.94RVU17A
2016-10-01$172.21$103.09RVU16D
2016-07-01$172.21$103.09RVU16C
2016-04-01$172.21$103.09RVU16B
2016-01-01$172.21$103.09RVU16A
2015-10-01$174.48$104.68RVU15D
2015-07-01$174.48$104.68RVU15C
2015-04-01$173.61$104.16RVU15B
2015-01-01$173.61$104.16RVU15A
2014-10-01$163.79$97.75RVU14D
2014-07-01$163.79$97.75RVU14C
2014-04-01$163.79$97.75RVU14B
2014-01-01$163.79$97.75RVU14A
2013-10-01$161.20$92.08RVU13D
2013-07-01$161.20$92.08RVU13C
2013-04-01$161.20$92.08RVU13B
2013-01-01$161.20$92.08RVU13AR

Price 11981 for an earlier date of service

Where the Queens, NY rate applies

Queens, NY is a Medicare payment area, not a city. Our Census mapping connects it to 1 cities and communities in New York. Some span more than one payment area; confirm with the service ZIP.

Browse all communities in New York

11981 billing questions

How does 11981 differ from 11980?

11981 is for inserting a non-biodegradable drug delivery implant, such as an etonogestrel contraceptive implant. 11980 describes insertion of hormone pellets.

Should the implant product be reported separately?

The insertion procedure and the drug implant product are distinct. For an etonogestrel contraceptive implant, HCPCS J7307 may report the product when applicable.

Is modifier 50 appropriate for two implants?

No. CMS identifies modifier 50 as inappropriate for 11981. Report the insertion service based on the procedure performed rather than billing it as a bilateral service.

What documentation supports 11981?

Document the implant or medication used, the insertion site, and that the implant was placed. For an upper-arm contraceptive implant, the record should support the completed insertion.

How are other procedures in the same session paid?

The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction when performed in the same session.

Can an assistant or co-surgeon be reported?

Assistant-at-surgery payment is allowed only when medical necessity is documented. Co-surgeons and team surgery are not permitted for this code.

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

Show the CMS file lines behind this rate
RVUs for 11981PPRRVU2026_Oct_nonQPP.csv, line 1,393 (RVU26D)
Geographic factors for Queens, NYGPCI2026.csv, line 81 (RVU26D)

Open CMS sourceHow we calculate rates

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