No office rate
Use 19357 for breast reconstruction with a tissue expander; it includes subsequent expansion. Code 11960 describes expander insertion in other reconstructive contexts.
On this page
CMS RVU26D · Effective 2026-10-01
11960 Tissue expander Medicare reimbursement rates in Delaware
Report tissue expander insertion when a surgeon places an expandable device beneath the skin to develop tissue for later reconstruction or coverage. Compare 11960 office and facility rates across CMS payment localities in Delaware.
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 11960 in Delaware?
Delaware has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$937.35
1 of 1 localities have a supported rate.
Payment area: Delaware
One mapped payment locality.
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.
Reconstructive surgery
About 11960: Subcutaneous tissue expander insertion
Report tissue expander insertion when a surgeon places an expandable device beneath the skin to develop tissue for later reconstruction or coverage.
A plastic or reconstructive surgeon places one or more expandable devices beneath the skin near an area that needs additional tissue. Expansion can prepare skin for reconstruction or coverage after problems such as burns, trauma, or removal of a lesion. Tissue expansion is used at sites including the scalp and extremities; breast reconstruction has its own specific code. Placement may occur in a hospital or another surgical setting.
Report this service for the expander placement itself, supported by the operative note describing the site, device placement, and reconstructive purpose. The 90-day global period includes the day-before preoperative visit and related postoperative care for 90 days. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and the others are subject to the standard multiple procedure reduction. Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery, and co-surgeon and team-surgery billing are not permitted.
CMS billing rules for 11960
- 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 adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- 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 RVU11.20 · 39%
- Practice expense (office) RVU15.21 · 54%
- Malpractice RVU1.98 · 7%
218
Medicare services in 2024 · #4250 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.
11960 compared with similar codes
Office rates for Delaware, from the same CMS release.
No office rate
11970 describes replacing an existing tissue expander with a permanent prosthesis, not placing the expander.
No office rate
11971 describes removing a tissue expander without inserting a permanent prosthesis; it is not the initial placement service.
Compare 11960 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.
1 of 1 payment localities
Delaware →
Office / nonfacility
Unavailable
Facility
$937.35
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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 11960 in Delaware.
PPRRVU2026_Oct_nonQPP.csv
1,388
- Code
- 11960
- Physician work
- 11.20
- Practice expense
- 15.21
- Malpractice
- 1.98
GPCI2026.csv
40
- Locality
- Delaware
- Physician work
- 1.005
- Practice expense
- 0.988
- Malpractice
- 0.899
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 11.20 | × 1.005 | 11.2560 |
| Practice expense | 15.21 | × 0.988 | 15.0275 |
| Malpractice | 1.98 | × 0.899 | 1.7800 |
| Total RVUs | 28.0635 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Delaware$937.35
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 11.2 | 1.005 |
| Practice expense | 15.21 | 0.988 |
| Malpractice | 1.98 | 0.899 |
(11.2 × 1.005 + 15.21 × 0.988 + 1.98 × 0.899) × $33.4009 = $937.35
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.
11960 billing questions
How is this different from breast reconstruction with a tissue expander?
For breast reconstruction with an expander, compare 19357, the breast-specific reconstruction service that includes subsequent expansion. Select the code that matches the operative service and site.
Is the code reported once for each expander?
The descriptor covers one or more expanders. Do not assign units by counting devices.
Does the 90-day global period include related postoperative care?
Yes. It includes the day-before preoperative visit and 90 days of related postoperative care.
Can modifier 50 be used when expanders are placed on both sides?
No. Bilateral adjustment does not apply to this code, and modifier 50 is inappropriate.
Can an assistant surgeon or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this code. Co-surgeons and team surgery are not permitted.
What happens when another procedure is performed in the same session?
The highest-valued procedure is paid in full; other procedures in that session are subject to the standard multiple procedure reduction.
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.
1,38511951,,Subq njx fil matrl 1.1-5.0cc,R,,1.16,2.14,,0.49,,0.21,3.51,1.86,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,38611952,,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
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899
4109102,FL,03,FORT LAUDERDALE,1.000,1.013,1.808
4209102,FL,04,MIAMI,1.000,1.041,2.529
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503