No office rate
Choose 11970 when the surgeon removes the expander and inserts a permanent implant in the same operation. Choose 11971 when no implant is inserted.
On this page
CMS RVU26D · Effective 2026-10-01
11971 in Madera
Office / nonfacility
Not available in this setting
Base rate per service
Facility setting
$523.23
Base rate per service
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
Reconstructive surgery
About 11971: Tissue expander removal without implant placement
Removal of a temporary tissue expander without placing an implant, commonly during breast reconstruction when expansion is discontinued or the device must be removed.
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.
CMS billing rules for 11971
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral procedure with modifier 50 is paid at 150%.
- Assistant at surgery
- Assistant at surgery is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU6.84 · 44%
- Practice expense (office) RVU7.32 · 47%
- Malpractice RVU1.28 · 8%
805
Medicare services in 2024 · #3143 by national volume
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.
11971 compared with similar codes
Office rates for Madera, from the same CMS release.
The same code, a different location
How does Madera compare?
11971 across payment areas
Same release and payment basis · bars start at $0
Madera · This locality
Unavailable
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
No comparable rate is available in this setting.
Other payment areas listed in California appear first, followed by selected cross-country examples. The chart compares amounts, not distance.
The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.
Compare all 108 other payment areas
Merced
California · 11971
Office
Unavailable
Facility
$523.23
No comparable office rate is available.
Modesto
California · 11971
Office
Unavailable
Facility
$523.23
No comparable office rate is available.
Napa
California · 11971
Office
Unavailable
Facility
$586.82
No comparable office rate is available.
Oxnard-Thousand Oaks-Ventura
California · 11971
Office
Unavailable
Facility
$550.49
No comparable office rate is available.
Redding
California · 11971
Office
Unavailable
Facility
$523.23
No comparable office rate is available.
Rest Of California
California · 11971
Office
Unavailable
Facility
$523.23
No comparable office rate is available.
Riverside-San Bernardino-Ontario
California · 11971
Office
Unavailable
Facility
$537.01
No comparable office rate is available.
Sacramento-Roseville-Folsom
California · 11971
Office
Unavailable
Facility
$543.95
No comparable office rate is available.
Salinas
California · 11971
Office
Unavailable
Facility
$541.83
No comparable office rate is available.
San Diego-Chula Vista-Carlsbad
California · 11971
Office
Unavailable
Facility
$550.90
No comparable office rate is available.
San Francisco-Oakland-Berkeley (Marin Cnty)
California · 11971
Office
Unavailable
Facility
$614.53
No comparable office rate is available.
San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)
California · 11971
Office
Unavailable
Facility
$613.07
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
California · 11971
Office
Unavailable
Facility
$629.07
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)
California · 11971
Office
Unavailable
Facility
$623.13
No comparable office rate is available.
San Luis Obispo-Paso Robles
California · 11971
Office
Unavailable
Facility
$533.74
No comparable office rate is available.
Santa Cruz-Watsonville
California · 11971
Office
Unavailable
Facility
$553.24
No comparable office rate is available.
Santa Maria-Santa Barbara
California · 11971
Office
Unavailable
Facility
$542.86
No comparable office rate is available.
Santa Rosa-Petaluma
California · 11971
Office
Unavailable
Facility
$558.47
No comparable office rate is available.
Stockton
California · 11971
Office
Unavailable
Facility
$523.23
No comparable office rate is available.
Vallejo
California · 11971
Office
Unavailable
Facility
$584.72
No comparable office rate is available.
Visalia
California · 11971
Office
Unavailable
Facility
$523.23
No comparable office rate is available.
Yuba City
California · 11971
Office
Unavailable
Facility
$523.23
No comparable office rate is available.
Dc + Md/Va Suburbs
District of Columbia · 11971
Office
Unavailable
Facility
$576.40
No comparable office rate is available.
Miami
Florida · 11971
Office
Unavailable
Facility
$591.10
No comparable office rate is available.
Chicago
Illinois · 11971
Office
Unavailable
Facility
$573.90
No comparable office rate is available.
Manhattan
New York · 11971
Office
Unavailable
Facility
$594.99
No comparable office rate is available.
Alaska*
Alaska · 11971
Office
Unavailable
Facility
$626.64
No comparable office rate is available.
Alabama
Alabama · 11971
Office
Unavailable
Facility
$466.59
No comparable office rate is available.
Arkansas
Arkansas · 11971
Office
Unavailable
Facility
$460.50
No comparable office rate is available.
Arizona
Arizona · 11971
Office
Unavailable
Facility
$501.97
No comparable office rate is available.
Colorado
Colorado · 11971
Office
Unavailable
Facility
$524.74
No comparable office rate is available.
Connecticut
Connecticut · 11971
Office
Unavailable
Facility
$548.08
No comparable office rate is available.
Delaware
Delaware · 11971
Office
Unavailable
Facility
$509.60
No comparable office rate is available.
Fort Lauderdale
Florida · 11971
Office
Unavailable
Facility
$553.43
No comparable office rate is available.
Rest Of Florida
Florida · 11971
Office
Unavailable
Facility
$526.46
No comparable office rate is available.
Atlanta
Georgia · 11971
Office
Unavailable
Facility
$528.90
No comparable office rate is available.
Rest Of Georgia
Georgia · 11971
Office
Unavailable
Facility
$497.51
No comparable office rate is available.
Hawaii, Guam
Hawaii · 11971
Office
Unavailable
Facility
$531.21
No comparable office rate is available.
Iowa
Iowa · 11971
Office
Unavailable
Facility
$469.15
No comparable office rate is available.
Idaho
Idaho · 11971
Office
Unavailable
Facility
$473.62
No comparable office rate is available.
East St. Louis
Illinois · 11971
Office
Unavailable
Facility
$539.50
No comparable office rate is available.
Rest Of Illinois
Illinois · 11971
Office
Unavailable
Facility
$518.51
No comparable office rate is available.
Suburban Chicago
Illinois · 11971
Office
Unavailable
Facility
$556.92
No comparable office rate is available.
Indiana
Indiana · 11971
Office
Unavailable
Facility
$475.89
No comparable office rate is available.
Kansas
Kansas · 11971
Office
Unavailable
Facility
$471.03
No comparable office rate is available.
Kentucky
Kentucky · 11971
Office
Unavailable
Facility
$484.94
No comparable office rate is available.
New Orleans
Louisiana · 11971
Office
Unavailable
Facility
$507.10
No comparable office rate is available.
Rest Of Louisiana
Louisiana · 11971
Office
Unavailable
Facility
$485.80
No comparable office rate is available.
Metropolitan Boston
Massachusetts · 11971
Office
Unavailable
Facility
$567.81
No comparable office rate is available.
Rest Of Massachusetts
Massachusetts · 11971
Office
Unavailable
Facility
$523.64
No comparable office rate is available.
Baltimore/Surr. Cntys
Maryland · 11971
Office
Unavailable
Facility
$547.35
No comparable office rate is available.
Rest Of Maryland
Maryland · 11971
Office
Unavailable
Facility
$517.42
No comparable office rate is available.
Rest Of Maine
Maine · 11971
Office
Unavailable
Facility
$479.99
No comparable office rate is available.
Southern Maine
Maine · 11971
Office
Unavailable
Facility
$497.73
No comparable office rate is available.
Detroit
Michigan · 11971
Office
Unavailable
Facility
$536.48
No comparable office rate is available.
Rest Of Michigan
Michigan · 11971
Office
Unavailable
Facility
$499.95
No comparable office rate is available.
Minnesota
Minnesota · 11971
Office
Unavailable
Facility
$492.70
No comparable office rate is available.
Metropolitan Kansas City
Missouri · 11971
Office
Unavailable
Facility
$499.81
No comparable office rate is available.
Metropolitan St. Louis
Missouri · 11971
Office
Unavailable
Facility
$504.06
No comparable office rate is available.
Rest Of Missouri
Missouri · 11971
Office
Unavailable
Facility
$480.86
No comparable office rate is available.
Mississippi
Mississippi · 11971
Office
Unavailable
Facility
$470.57
No comparable office rate is available.
Montana**
Montana · 11971
Office
Unavailable
Facility
$515.62
No comparable office rate is available.
North Carolina
North Carolina · 11971
Office
Unavailable
Facility
$483.89
No comparable office rate is available.
North Dakota**
North Dakota · 11971
Office
Unavailable
Facility
$490.31
No comparable office rate is available.
Nebraska
Nebraska · 11971
Office
Unavailable
Facility
$470.29
No comparable office rate is available.
New Hampshire
New Hampshire · 11971
Office
Unavailable
Facility
$520.39
No comparable office rate is available.
Northern Nj
New Jersey · 11971
Office
Unavailable
Facility
$572.13
No comparable office rate is available.
Rest Of New Jersey
New Jersey · 11971
Office
Unavailable
Facility
$551.49
No comparable office rate is available.
New Mexico
New Mexico · 11971
Office
Unavailable
Facility
$504.01
No comparable office rate is available.
Nevada**
Nevada · 11971
Office
Unavailable
Facility
$508.81
No comparable office rate is available.
Nyc Suburbs/Long Island
New York · 11971
Office
Unavailable
Facility
$613.18
No comparable office rate is available.
Poughkpsie/N Nyc Suburbs
New York · 11971
Office
Unavailable
Facility
$558.20
No comparable office rate is available.
Queens
New York · 11971
Office
Unavailable
Facility
$593.73
No comparable office rate is available.
Rest Of New York
New York · 11971
Office
Unavailable
Facility
$490.79
No comparable office rate is available.
Ohio
Ohio · 11971
Office
Unavailable
Facility
$494.78
No comparable office rate is available.
Oklahoma
Oklahoma · 11971
Office
Unavailable
Facility
$480.02
No comparable office rate is available.
Portland
Oregon · 11971
Office
Unavailable
Facility
$535.56
No comparable office rate is available.
Rest Of Oregon
Oregon · 11971
Office
Unavailable
Facility
$502.03
No comparable office rate is available.
Metropolitan Philadelphia
Pennsylvania · 11971
Office
Unavailable
Facility
$538.10
No comparable office rate is available.
Rest Of Pennsylvania
Pennsylvania · 11971
Office
Unavailable
Facility
$493.31
No comparable office rate is available.
Puerto Rico
Puerto Rico · 11971
Office
Unavailable
Facility
$517.76
No comparable office rate is available.
Rhode Island
Rhode Island · 11971
Office
Unavailable
Facility
$523.50
No comparable office rate is available.
South Carolina
South Carolina · 11971
Office
Unavailable
Facility
$490.72
No comparable office rate is available.
South Dakota**
South Dakota · 11971
Office
Unavailable
Facility
$487.32
No comparable office rate is available.
Tennessee
Tennessee · 11971
Office
Unavailable
Facility
$473.67
No comparable office rate is available.
Austin
Texas · 11971
Office
Unavailable
Facility
$525.47
No comparable office rate is available.
Beaumont
Texas · 11971
Office
Unavailable
Facility
$490.67
No comparable office rate is available.
Brazoria
Texas · 11971
Office
Unavailable
Facility
$505.93
No comparable office rate is available.
Dallas
Texas · 11971
Office
Unavailable
Facility
$510.72
No comparable office rate is available.
Fort Worth
Texas · 11971
Office
Unavailable
Facility
$508.83
No comparable office rate is available.
Galveston
Texas · 11971
Office
Unavailable
Facility
$508.47
No comparable office rate is available.
Houston
Texas · 11971
Office
Unavailable
Facility
$531.90
No comparable office rate is available.
Rest Of Texas
Texas · 11971
Office
Unavailable
Facility
$499.09
No comparable office rate is available.
Utah
Utah · 11971
Office
Unavailable
Facility
$496.68
No comparable office rate is available.
Virginia
Virginia · 11971
Office
Unavailable
Facility
$498.98
No comparable office rate is available.
Virgin Islands
United States Virgin Islands · 11971
Office
Unavailable
Facility
$517.76
No comparable office rate is available.
Vermont
Vermont · 11971
Office
Unavailable
Facility
$492.14
No comparable office rate is available.
Rest Of Washington
Washington · 11971
Office
Unavailable
Facility
$521.42
No comparable office rate is available.
Seattle (King Cnty)
Washington · 11971
Office
Unavailable
Facility
$574.81
No comparable office rate is available.
Wisconsin
Wisconsin · 11971
Office
Unavailable
Facility
$475.86
No comparable office rate is available.
West Virginia
West Virginia · 11971
Office
Unavailable
Facility
$502.11
No comparable office rate is available.
Wyoming**
Wyoming · 11971
Office
Unavailable
Facility
$504.59
No comparable office rate is available.
See how rates vary across the country
11971 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.
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 all state and territory rates as a table
| State / territory | Rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
Where does this rate apply?
Madera is a Medicare payment area. Our Census mapping connects it to 17 cities and communities in California, including the examples shown here.
Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.
Use this rate
What is a percentage of Medicare worth?
Turn a percentage into dollars for 11971 in Madera. This uses the base rate on this page, so the locality and release stay consistent.
Reference amount per service
$575.55
$523.23 × 110% = $575.55
A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.
Working with a whole code list?
Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.
How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 11971 in Madera.
PPRRVU2026_Oct_nonQPP.csv
1,390
- Code
- 11971
- Physician work
- 6.84
- Practice expense
- 7.32
- Malpractice
- 1.28
GPCI2026.csv
14
- Locality
- Madera
- Physician work
- 1.017
- Practice expense
- 1.096
- Malpractice
- 0.536
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 6.84 | × 1.017 | 6.9563 |
| Practice expense | 7.32 | × 1.096 | 8.0227 |
| Malpractice | 1.28 | × 0.536 | 0.6861 |
| Total RVUs | 15.6651 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Madera$523.23
Open 11971 in the RVU calculator →
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 6.84 | 1.017 |
| Practice expense | 7.32 | 1.096 |
| Malpractice | 1.28 | 0.536 |
(6.84 × 1.017 + 7.32 × 1.096 + 1.28 × 0.536) × $33.4009 = $523.23
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
How this rate has changed
11971 · Office / nonfacility
Rate unavailable
Effective 2026-10-01
A rate is unavailable in one of these releases, so a change cannot be calculated.
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
Explore release dates and calculate this code in an earlier period →
Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.
Inspect every release and its CMS source
| Effective from | Office / nonfacility | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | Not available in this setting | $523.23 | RVU26D |
| 2026-07-01 | Not available in this setting | $523.23 | RVU26C |
| 2026-04-01 | Not available in this setting | $523.23 | RVU26B |
| 2026-01-01 | Not available in this setting | $523.23 | RVU26A |
| 2025-10-01 | Not available in this setting | $555.90 | RVU25D |
| 2025-07-01 | Not available in this setting | $555.90 | RVU25C |
| 2025-04-01 | Not available in this setting | $555.90 | RVU25B |
| 2025-01-01 | Not available in this setting | $555.90 | RVU25A |
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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
1,38711954,,Subq njx fil matrl>10.0 cc,R,,1.80,3.04,,0.73,,0.35,5.19,2.88,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,38811960,,Insert tissue expander(s),A,,11.20,15.21,NA,15.21,,1.98,28.39,28.39,0,090,0.10,0.71,0.19,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,38911970,,Rplcmt tiss xpndr perm implt,A,,7.30,6.84,NA,6.84,,1.35,15.49,15.49,0,090,0.10,0.71,0.19,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,39011971,,Rmvl tis xpndr wo insj implt,A,,6.84,7.32,NA,7.32,,1.28,15.44,15.44,0,090,0.10,0.71,0.19,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,39111976,,Remove contraceptive capsule,R,,1.74,2.35,,0.36,,0.30,4.39,2.40,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,39211980,,Implant hormone pellet(s),A,,1.07,1.67,,0.23,,0.15,2.89,1.45,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,39311981,,Insertion drug dlvr implant,A,,1.11,1.90,,0.32,,0.21,3.22,1.64,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1101112,CA,56,FRESNO,1.017,1.096,0.536
1201112,CA,57,HANFORD-CORCORAN,1.017,1.096,0.536
1301182,CA,18,LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY),1.041,1.183,0.664
1401112,CA,58,MADERA,1.017,1.096,0.536
1501112,CA,59,MERCED,1.017,1.096,0.536
1601112,CA,60,MODESTO,1.017,1.096,0.536
1701112,CA,51,NAPA,1.063,1.318,0.508