No office rate
Use 11960 for insertion of a tissue expander. Use 11970 when the procedure exchanges an existing expander for a permanent implant.
On this page
CMS RVU26D · Effective 2026-10-01
11970 in Redding
Office / nonfacility
Not available in this setting
Base rate per service
Facility setting
$522.54
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.
Breast reconstruction
About 11970: Tissue expander to implant exchange
Reports exchange of a tissue expander for a permanent implant, commonly during the later stage of breast reconstruction after mastectomy.
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.
CMS billing rules for 11970
- 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
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU7.30 · 47%
- Practice expense (office) RVU6.84 · 44%
- Malpractice RVU1.35 · 9%
2.7K
Medicare services in 2024 · #2251 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.
11970 compared with similar codes
Office rates for Redding, from the same CMS release.
No office rate
11971 describes removal of a tissue expander without implant insertion; 11970 describes an exchange that includes permanent implant placement.
No office rate
19342 covers breast implant insertion or replacement on a separate day from mastectomy. 11970 specifically describes exchanging a tissue expander for a permanent implant.
The same code, a different location
How does Redding compare?
11970 across payment areas
Same release and payment basis · bars start at $0
Redding · 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
Madera
California · 11970
Office
Unavailable
Facility
$522.54
No comparable office rate is available.
Merced
California · 11970
Office
Unavailable
Facility
$522.54
No comparable office rate is available.
Modesto
California · 11970
Office
Unavailable
Facility
$522.54
No comparable office rate is available.
Napa
California · 11970
Office
Unavailable
Facility
$583.21
No comparable office rate is available.
Oxnard-Thousand Oaks-Ventura
California · 11970
Office
Unavailable
Facility
$548.79
No comparable office rate is available.
Rest Of California
California · 11970
Office
Unavailable
Facility
$522.54
No comparable office rate is available.
Riverside-San Bernardino-Ontario
California · 11970
Office
Unavailable
Facility
$537.07
No comparable office rate is available.
Sacramento-Roseville-Folsom
California · 11970
Office
Unavailable
Facility
$542.47
No comparable office rate is available.
Salinas
California · 11970
Office
Unavailable
Facility
$540.34
No comparable office rate is available.
San Diego-Chula Vista-Carlsbad
California · 11970
Office
Unavailable
Facility
$548.82
No comparable office rate is available.
San Francisco-Oakland-Berkeley (Marin Cnty)
California · 11970
Office
Unavailable
Facility
$609.82
No comparable office rate is available.
San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)
California · 11970
Office
Unavailable
Facility
$608.29
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
California · 11970
Office
Unavailable
Facility
$624.26
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)
California · 11970
Office
Unavailable
Facility
$617.99
No comparable office rate is available.
San Luis Obispo-Paso Robles
California · 11970
Office
Unavailable
Facility
$532.36
No comparable office rate is available.
Santa Cruz-Watsonville
California · 11970
Office
Unavailable
Facility
$550.70
No comparable office rate is available.
Santa Maria-Santa Barbara
California · 11970
Office
Unavailable
Facility
$541.21
No comparable office rate is available.
Santa Rosa-Petaluma
California · 11970
Office
Unavailable
Facility
$555.86
No comparable office rate is available.
Stockton
California · 11970
Office
Unavailable
Facility
$522.54
No comparable office rate is available.
Vallejo
California · 11970
Office
Unavailable
Facility
$581.00
No comparable office rate is available.
Visalia
California · 11970
Office
Unavailable
Facility
$522.54
No comparable office rate is available.
Yuba City
California · 11970
Office
Unavailable
Facility
$522.54
No comparable office rate is available.
Dc + Md/Va Suburbs
District of Columbia · 11970
Office
Unavailable
Facility
$576.31
No comparable office rate is available.
Miami
Florida · 11970
Office
Unavailable
Facility
$595.69
No comparable office rate is available.
Chicago
Illinois · 11970
Office
Unavailable
Facility
$578.62
No comparable office rate is available.
Manhattan
New York · 11970
Office
Unavailable
Facility
$596.42
No comparable office rate is available.
Alaska*
Alaska · 11970
Office
Unavailable
Facility
$633.90
No comparable office rate is available.
Alabama
Alabama · 11970
Office
Unavailable
Facility
$469.25
No comparable office rate is available.
Arkansas
Arkansas · 11970
Office
Unavailable
Facility
$463.30
No comparable office rate is available.
Arizona
Arizona · 11970
Office
Unavailable
Facility
$503.80
No comparable office rate is available.
Colorado
Colorado · 11970
Office
Unavailable
Facility
$525.05
No comparable office rate is available.
Connecticut
Connecticut · 11970
Office
Unavailable
Facility
$549.32
No comparable office rate is available.
Delaware
Delaware · 11970
Office
Unavailable
Facility
$511.30
No comparable office rate is available.
Fort Lauderdale
Florida · 11970
Office
Unavailable
Facility
$556.78
No comparable office rate is available.
Rest Of Florida
Florida · 11970
Office
Unavailable
Facility
$530.01
No comparable office rate is available.
Atlanta
Georgia · 11970
Office
Unavailable
Facility
$530.83
No comparable office rate is available.
Rest Of Georgia
Georgia · 11970
Office
Unavailable
Facility
$501.36
No comparable office rate is available.
Hawaii, Guam
Hawaii · 11970
Office
Unavailable
Facility
$529.70
No comparable office rate is available.
Iowa
Iowa · 11970
Office
Unavailable
Facility
$470.77
No comparable office rate is available.
Idaho
Idaho · 11970
Office
Unavailable
Facility
$475.34
No comparable office rate is available.
East St. Louis
Illinois · 11970
Office
Unavailable
Facility
$544.83
No comparable office rate is available.
Rest Of Illinois
Illinois · 11970
Office
Unavailable
Facility
$522.89
No comparable office rate is available.
Suburban Chicago
Illinois · 11970
Office
Unavailable
Facility
$560.07
No comparable office rate is available.
Indiana
Indiana · 11970
Office
Unavailable
Facility
$477.53
No comparable office rate is available.
Kansas
Kansas · 11970
Office
Unavailable
Facility
$473.08
No comparable office rate is available.
Kentucky
Kentucky · 11970
Office
Unavailable
Facility
$488.19
No comparable office rate is available.
New Orleans
Louisiana · 11970
Office
Unavailable
Facility
$510.03
No comparable office rate is available.
Rest Of Louisiana
Louisiana · 11970
Office
Unavailable
Facility
$489.21
No comparable office rate is available.
Metropolitan Boston
Massachusetts · 11970
Office
Unavailable
Facility
$566.74
No comparable office rate is available.
Rest Of Massachusetts
Massachusetts · 11970
Office
Unavailable
Facility
$524.24
No comparable office rate is available.
Baltimore/Surr. Cntys
Maryland · 11970
Office
Unavailable
Facility
$548.65
No comparable office rate is available.
Rest Of Maryland
Maryland · 11970
Office
Unavailable
Facility
$518.86
No comparable office rate is available.
Rest Of Maine
Maine · 11970
Office
Unavailable
Facility
$482.06
No comparable office rate is available.
Southern Maine
Maine · 11970
Office
Unavailable
Facility
$498.69
No comparable office rate is available.
Detroit
Michigan · 11970
Office
Unavailable
Facility
$540.32
No comparable office rate is available.
Rest Of Michigan
Michigan · 11970
Office
Unavailable
Facility
$503.32
No comparable office rate is available.
Minnesota
Minnesota · 11970
Office
Unavailable
Facility
$492.26
No comparable office rate is available.
Metropolitan Kansas City
Missouri · 11970
Office
Unavailable
Facility
$502.41
No comparable office rate is available.
Metropolitan St. Louis
Missouri · 11970
Office
Unavailable
Facility
$506.50
No comparable office rate is available.
Rest Of Missouri
Missouri · 11970
Office
Unavailable
Facility
$484.68
No comparable office rate is available.
Mississippi
Mississippi · 11970
Office
Unavailable
Facility
$473.85
No comparable office rate is available.
Montana**
Montana · 11970
Office
Unavailable
Facility
$517.29
No comparable office rate is available.
North Carolina
North Carolina · 11970
Office
Unavailable
Facility
$485.80
No comparable office rate is available.
North Dakota**
North Dakota · 11970
Office
Unavailable
Facility
$490.60
No comparable office rate is available.
Nebraska
Nebraska · 11970
Office
Unavailable
Facility
$471.74
No comparable office rate is available.
New Hampshire
New Hampshire · 11970
Office
Unavailable
Facility
$521.11
No comparable office rate is available.
Northern Nj
New Jersey · 11970
Office
Unavailable
Facility
$572.36
No comparable office rate is available.
Rest Of New Jersey
New Jersey · 11970
Office
Unavailable
Facility
$552.53
No comparable office rate is available.
New Mexico
New Mexico · 11970
Office
Unavailable
Facility
$507.48
No comparable office rate is available.
Nevada**
Nevada · 11970
Office
Unavailable
Facility
$510.08
No comparable office rate is available.
Nyc Suburbs/Long Island
New York · 11970
Office
Unavailable
Facility
$614.81
No comparable office rate is available.
Poughkpsie/N Nyc Suburbs
New York · 11970
Office
Unavailable
Facility
$559.53
No comparable office rate is available.
Queens
New York · 11970
Office
Unavailable
Facility
$594.50
No comparable office rate is available.
Rest Of New York
New York · 11970
Office
Unavailable
Facility
$492.56
No comparable office rate is available.
Ohio
Ohio · 11970
Office
Unavailable
Facility
$497.86
No comparable office rate is available.
Oklahoma
Oklahoma · 11970
Office
Unavailable
Facility
$482.88
No comparable office rate is available.
Portland
Oregon · 11970
Office
Unavailable
Facility
$535.10
No comparable office rate is available.
Rest Of Oregon
Oregon · 11970
Office
Unavailable
Facility
$503.07
No comparable office rate is available.
Metropolitan Philadelphia
Pennsylvania · 11970
Office
Unavailable
Facility
$539.84
No comparable office rate is available.
Rest Of Pennsylvania
Pennsylvania · 11970
Office
Unavailable
Facility
$496.17
No comparable office rate is available.
Puerto Rico
Puerto Rico · 11970
Office
Unavailable
Facility
$519.22
No comparable office rate is available.
Rhode Island
Rhode Island · 11970
Office
Unavailable
Facility
$524.68
No comparable office rate is available.
South Carolina
South Carolina · 11970
Office
Unavailable
Facility
$493.25
No comparable office rate is available.
South Dakota**
South Dakota · 11970
Office
Unavailable
Facility
$487.44
No comparable office rate is available.
Tennessee
Tennessee · 11970
Office
Unavailable
Facility
$475.71
No comparable office rate is available.
Austin
Texas · 11970
Office
Unavailable
Facility
$525.98
No comparable office rate is available.
Beaumont
Texas · 11970
Office
Unavailable
Facility
$493.62
No comparable office rate is available.
Brazoria
Texas · 11970
Office
Unavailable
Facility
$507.35
No comparable office rate is available.
Dallas
Texas · 11970
Office
Unavailable
Facility
$512.26
No comparable office rate is available.
Fort Worth
Texas · 11970
Office
Unavailable
Facility
$510.56
No comparable office rate is available.
Galveston
Texas · 11970
Office
Unavailable
Facility
$509.98
No comparable office rate is available.
Houston
Texas · 11970
Office
Unavailable
Facility
$534.69
No comparable office rate is available.
Rest Of Texas
Texas · 11970
Office
Unavailable
Facility
$501.35
No comparable office rate is available.
Utah
Utah · 11970
Office
Unavailable
Facility
$499.07
No comparable office rate is available.
Virginia
Virginia · 11970
Office
Unavailable
Facility
$500.24
No comparable office rate is available.
Virgin Islands
United States Virgin Islands · 11970
Office
Unavailable
Facility
$519.22
No comparable office rate is available.
Vermont
Vermont · 11970
Office
Unavailable
Facility
$492.82
No comparable office rate is available.
Rest Of Washington
Washington · 11970
Office
Unavailable
Facility
$521.88
No comparable office rate is available.
Seattle (King Cnty)
Washington · 11970
Office
Unavailable
Facility
$573.18
No comparable office rate is available.
Wisconsin
Wisconsin · 11970
Office
Unavailable
Facility
$476.58
No comparable office rate is available.
West Virginia
West Virginia · 11970
Office
Unavailable
Facility
$506.89
No comparable office rate is available.
Wyoming**
Wyoming · 11970
Office
Unavailable
Facility
$505.66
No comparable office rate is available.
See how rates vary across the country
11970 · 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?
Redding is a Medicare payment area. Our Census mapping connects it to 32 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 11970 in Redding. This uses the base rate on this page, so the locality and release stay consistent.
Reference amount per service
$574.79
$522.54 × 110% = $574.79
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 11970 in Redding.
PPRRVU2026_Oct_nonQPP.csv
1,389
- Code
- 11970
- Physician work
- 7.30
- Practice expense
- 6.84
- Malpractice
- 1.35
GPCI2026.csv
19
- Locality
- Redding
- Physician work
- 1.017
- Practice expense
- 1.096
- Malpractice
- 0.536
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 7.30 | × 1.017 | 7.4241 |
| Practice expense | 6.84 | × 1.096 | 7.4966 |
| Malpractice | 1.35 | × 0.536 | 0.7236 |
| Total RVUs | 15.6443 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Redding$522.54
Open 11970 in the RVU calculator →
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 7.3 | 1.017 |
| Practice expense | 6.84 | 1.096 |
| Malpractice | 1.35 | 0.536 |
(7.3 × 1.017 + 6.84 × 1.096 + 1.35 × 0.536) × $33.4009 = $522.54
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
11970 · 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 | $522.54 | RVU26D |
| 2026-07-01 | Not available in this setting | $522.54 | RVU26C |
| 2026-04-01 | Not available in this setting | $522.54 | RVU26B |
| 2026-01-01 | Not available in this setting | $522.54 | RVU26A |
| 2025-10-01 | Not available in this setting | $562.34 | RVU25D |
| 2025-07-01 | Not available in this setting | $562.34 | RVU25C |
| 2025-04-01 | Not available in this setting | $562.34 | RVU25B |
| 2025-01-01 | Not available in this setting | $562.34 | RVU25A |
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 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.
1,38611952,,Subq njx fil matrl 5.1-10cc,R,,1.65,2.74,,0.67,,0.30,4.69,2.62,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,38711954,,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
1601112,CA,60,MODESTO,1.017,1.096,0.536
1701112,CA,51,NAPA,1.063,1.318,0.508
1801182,CA,17,OXNARD-THOUSAND OAKS-VENTURA,1.028,1.182,0.623
1901112,CA,61,REDDING,1.017,1.096,0.536
2001112,CA,62,RIVERSIDE-SAN BERNARDINO-ONTARIO,1.018,1.096,0.853
2101112,CA,63,SACRAMENTO-ROSEVILLE-FOLSOM,1.036,1.163,0.536
2201112,CA,64,SALINAS,1.031,1.159,0.536