FeeBase
Log inGet started
Menu

Billing code 11970: Implant exchangeMedicare rate & RVUs

Reports exchange of a tissue expander for a permanent implant, commonly during the later stage of breast reconstruction after mastectomy.

CMS RVU26DEffective Oct 1, 2026109 payment localities2.7K Medicare services in 2024

Medicare pays $517.38 for 11970 nationally in a facility.

Medicare rate · 11970

Implant exchange

Swap in your local Medicare rate.

Work RVUs
7.3
Total RVUs
15.49
Global days
090

National rate · 2026

$517.38

Facility setting, before claim adjustments.

See every locality for 11970 → · Billed by an NP, PA or therapist? →

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

On this page 10 sections
  1. Medicare rate
  2. What 11970 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 11970 covers

This code describes the operative exchange of a temporary tissue expander for a permanent implant. It is commonly used by plastic surgeons for the later stage of breast reconstruction after mastectomy, once expansion is complete. The exchange includes removing the expander and placing the permanent implant; it is distinct from an operation that only inserts an expander or only removes one.

Select the code when the operative report supports an expander-to-implant exchange, and document the reconstruction site, laterality, and work performed. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in the same session, the highest-valued procedure is paid in full and others at 50%. A bilateral procedure reported with modifier 50 is paid at 150%. Medicare does not pay an assistant at surgery for this service; 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 11970 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

11970 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$469.25
Alaska*Unavailable$633.90
ArizonaUnavailable$503.80
ArkansasUnavailable$463.30
AtlantaUnavailable$530.83
AustinUnavailable$525.98
BakersfieldUnavailable$526.31
Baltimore/Surr. CntysUnavailable$548.65
BeaumontUnavailable$493.62
BrazoriaUnavailable$507.35

11970 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.

View every state and territory as a table
11970 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 11970 rate is calculated

Each of 11970’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 · 11970

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 7.30Practice expense 6.84Malpractice 1.35

15.4900 adjusted RVUs×$33.4009 conversion factor=$517.38

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 11970

11970 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 11970

Implant exchange

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.71/0.19Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 11970

Implant exchange

90-day global period ends

Dec 30, 2026

Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).

Visit on Oct 31, 2026

Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.

  • 24 Unrelated E/M visit by the same physician
  • 79 Unrelated procedure (starts its own global period)
  • 58 Staged, more extensive, or therapy procedure that was planned
  • 78 Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 50 · payment effect

With and without the modifier

11970 without 50 · national facility

$517.38

Implant exchange

11970-50 · Bilateral: 150%

$776.07

Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).

When to use modifier 50

11970 compared with similar codes

Compare codes

11970 vs 11960 vs 11971 vs 19342: national Medicare rates

Swap in your local Medicare rate.

  • 11970
    Implant exchange · 7.3 wRVU
    —
  • 11960
    Tissue expander · 11.2 wRVU
    —
  • 11971
    Expander removal · 6.84 wRVU
    —
  • 19342
    Breast implant · 10.22 wRVU
    —

How to choose

11960Tissue expander
Use 11960 for insertion of a tissue expander. Use 11970 when the procedure exchanges an existing expander for a permanent implant.
11971Expander removal
11971 describes removal of a tissue expander without implant insertion; 11970 describes an exchange that includes permanent implant placement.
19342Breast implant
19342 covers breast implant insertion or replacement on a separate day from mastectomy. 11970 specifically describes exchanging a tissue expander for a permanent implant.

Codes related to 11970

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

Codes related to 11970
CodeHow it relatesNational office range
Same family
11960Tissue expanderExpander insertion, rather than exchange of an expander for a permanent implant.No office rate
11971Expander removalExpander removal without placement of a permanent implant.No office rate
Used instead
19342Breast implantBreast implant insertion or replacement on a separate day from mastectomy, without this expander-exchange service.No office rate

11970 billing questions

When is 11970 reported instead of 11960?

Report 11970 for an exchange from a tissue expander to a permanent implant. Code 11960 describes expander insertion, an earlier stage rather than the exchange.

How does 11970 differ from 11971?

11970 describes removing the expander and placing a permanent implant. 11971 is for expander removal without implant insertion.

Is modifier 50 used when both sides are treated?

CMS identifies this as a bilateral procedure; when reported with modifier 50, it is paid at 150%.

What is included in the Medicare global period?

The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.

What documentation supports 11970?

The operative report should establish that the surgeon removed a tissue expander and placed a permanent implant, and identify the site and laterality.

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 11970PPRRVU2026_Oct_nonQPP.csv, line 1,389 (RVU26D)

Open CMS sourceHow we calculate rates

Did this answer your question about what 11970 pays?

Tell us what you were actually trying to work out. We’ll answer you directly, or build the page that does.

Fee sheets

Put 11970 and the rest of your codes on one sheet

Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.

Build my fee sheetOr price your code list free →