Billing code 11971: Expander removalMedicare rate & RVUs in Georgia
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 doesn’t publish an office rate for 11971 in Georgia.
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 9 sections
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 in Georgia
| Payment locality | Office | Facility |
|---|---|---|
| Atlanta | Unavailable | $528.90 |
| Rest Of Georgia | Unavailable | $497.51 |
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
Work6.84
6.84 RVUs× 1.000 GPCI
Practice expense7.32
7.32 RVUs× 1.000 GPCI
Malpractice1.28
1.28 RVUs× 1.000 GPCI
Adjusted RVUs
15.4400
Conversion factor
$33.4009
Medicare rate
$515.71
Every GPCI starts 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
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.71/0.19 | Share 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.
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).
11971 compared with similar codes
Compare codes · National
4 codes, side by side
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.
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
Fee sheets
Put 11971 and the rest of your codes on one sheet
Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.
Build my fee sheetOr price your code list free →