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.
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CMS RVU26D · Effective 2026-10-01
11971 Expander removal Medicare reimbursement rates in California
Removal of a temporary tissue expander without placing an implant, commonly during breast reconstruction when expansion is discontinued or the device must be removed. Compare 11971 office and facility rates across CMS payment localities in California.
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.
What does Medicare pay for 11971 in California?
California has 29 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 29 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$523.23–$629.07
29 of 29 localities have a supported rate.
Lowest: Chico
Highest: San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
A spread of $105.84 per service.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Where 11971 pays more and less in California
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 California, from the same CMS release.
Compare 11971 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield | Office Unavailable | Facility $526.81 |
| Chico | Office Unavailable | Facility $523.23 |
| El Centro | Office Unavailable | Facility $523.44 |
| Fresno | Office Unavailable | Facility $523.23 |
| Hanford-Corcoran | Office Unavailable | Facility $523.23 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | Office Unavailable | Facility $555.45 |
| Madera | Office Unavailable | Facility $523.23 |
| Merced | Office Unavailable | Facility $523.23 |
| Modesto | Office Unavailable | Facility $523.23 |
| Napa | Office Unavailable | Facility $586.82 |
| Oxnard-Thousand Oaks-Ventura | Office Unavailable | Facility $550.49 |
| Redding | Office Unavailable | Facility $523.23 |
| Rest Of California | Office Unavailable | Facility $523.23 |
| Riverside-San Bernardino-Ontario | Office Unavailable | Facility $537.01 |
| Sacramento-Roseville-Folsom | Office Unavailable | Facility $543.95 |
| Salinas | Office Unavailable | Facility $541.83 |
| San Diego-Chula Vista-Carlsbad | Office Unavailable | Facility $550.90 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | Office Unavailable | Facility $614.53 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | Office Unavailable | Facility $613.07 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | Office Unavailable | Facility $629.07 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | Office Unavailable | Facility $623.13 |
| San Luis Obispo-Paso Robles | Office Unavailable | Facility $533.74 |
| Santa Cruz-Watsonville | Office Unavailable | Facility $553.24 |
| Santa Maria-Santa Barbara | Office Unavailable | Facility $542.86 |
| Santa Rosa-Petaluma | Office Unavailable | Facility $558.47 |
| Stockton | Office Unavailable | Facility $523.23 |
| Vallejo | Office Unavailable | Facility $584.72 |
| Visalia | Office Unavailable | Facility $523.23 |
| Yuba City | Office Unavailable | Facility $523.23 |
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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