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Billing code 11971: Expander removalMedicare rate & RVUs

Removal of a temporary tissue expander without placing an implant, commonly during breast reconstruction when expansion is discontinued or the device must be removed.

CMS RVU26DEffective Oct 1, 2026109 payment localities805 Medicare services in 2024

Medicare pays $515.71 for 11971 nationally in a facility.

Medicare rate · 11971

Expander removal

Swap in your local Medicare rate.

Work RVUs
6.84
Total RVUs
15.44
Global days
090

National rate · 2026

$515.71

Facility setting, before claim adjustments.

See every locality for 11971 → · 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 11971 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 11971 covers

The surgeon removes a temporary tissue expander from its reconstructive pocket without inserting a permanent implant during that operation. Plastic and reconstructive surgeons most often perform this service during staged breast reconstruction, such as when an expander is removed because of infection, exposure, or a decision not to proceed with implant reconstruction. Tissue expanders used at other reconstructive sites may also be removed under this code when the service fits the code’s scope.

Report 11971 when the operative service removes the expander and no implant is inserted; an expander-to-implant exchange is a different service. The operative report should identify the site and side, the expander removal, and whether an implant was placed. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment requires documented 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.

Where 11971 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

11971 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$466.59
Alaska*Unavailable$626.64
ArizonaUnavailable$501.97
ArkansasUnavailable$460.50
AtlantaUnavailable$528.90
AustinUnavailable$525.47
BakersfieldUnavailable$526.81
Baltimore/Surr. CntysUnavailable$547.35
BeaumontUnavailable$490.67
BrazoriaUnavailable$505.93

11971 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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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
11971 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 11971 rate is calculated

Each of 11971’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 · 11971

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 6.84Practice expense 7.32Malpractice 1.28

15.4400 adjusted RVUs×$33.4009 conversion factor=$515.71

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

Payment rules and modifiers for 11971

11971 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 11971

Expander removal

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)0Not paid without supporting documentation.
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 · 11971

Expander removal

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

11971 without 50 · national facility

$515.71

Expander removal

11971-50 · Bilateral: 150%

$773.57

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

11971 compared with similar codes

Compare codes

11971 vs 11970 vs 11960 vs 19328: national Medicare rates

Swap in your local Medicare rate.

  • 11971
    Expander removal · 6.84 wRVU
    —
  • 11970
    Implant exchange · 7.3 wRVU
    —
  • 11960
    Tissue expander · 11.2 wRVU
    —
  • 19328
    Implant removal · 7.25 wRVU
    —

How to choose

11970Implant exchange
Choose 11970 when the surgeon removes the expander and inserts a permanent implant in the same operation. Choose 11971 when no implant is inserted.
11960Tissue expander
11960 reports tissue expander insertion; 11971 reports removal without implant placement.
19328Implant removal
19328 concerns removal of an intact breast implant. 11971 is for removal of a tissue expander.

Codes related to 11971

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

Codes related to 11971
CodeHow it relatesNational office range
Used instead
11970Implant exchangeUsed when the tissue expander is exchanged for a permanent implant rather than removed alone.No office rate
19328Implant removalRemoval code for an intact breast implant, not a temporary tissue expander.No office rate
Same family
11960Tissue expanderCovers insertion of tissue expander(s), an earlier step in an expander-based reconstruction sequence.No office rate

11971 billing questions

When should 11971 be used instead of 11970?

Use 11971 when the tissue expander is removed without an implant being inserted. Use 11970 for an operation that replaces the expander with a permanent implant.

Can 11971 be reported for both breasts?

For bilateral removal, report the service with modifier 50 under the CMS bilateral rule; payment is at 150%. Document the treated sides and the work performed.

What documentation supports 11971?

The operative report should establish that a tissue expander was removed, identify its anatomic site and side, and clarify that no implant was inserted during the operation.

Are related postoperative visits included?

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

Can an assistant surgeon be paid for 11971?

Assistant-at-surgery payment is available only when medical necessity is documented. CMS does not permit co-surgeons or team surgery 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 11971PPRRVU2026_Oct_nonQPP.csv, line 1,390 (RVU26D)

Open CMS sourceHow we calculate rates

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