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 Implant exchange Medicare reimbursement rates in Kentucky
Reports exchange of a tissue expander for a permanent implant, commonly during the later stage of breast reconstruction after mastectomy. Compare 11970 office and facility rates across CMS payment localities in Kentucky.
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 11970 in Kentucky?
Kentucky 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
$488.19
1 of 1 localities have a supported rate.
Payment area: Kentucky
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.
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 Kentucky, 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.
Compare 11970 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
Kentucky →
Office / nonfacility
Unavailable
Facility
$488.19
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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 11970 in Kentucky.
PPRRVU2026_Oct_nonQPP.csv
1,389
- Code
- 11970
- Physician work
- 7.30
- Practice expense
- 6.84
- Malpractice
- 1.35
GPCI2026.csv
55
- Locality
- Kentucky
- Physician work
- 1.000
- Practice expense
- 0.889
- Malpractice
- 0.915
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 7.30 | × 1.000 | 7.3000 |
| Practice expense | 6.84 | × 0.889 | 6.0808 |
| Malpractice | 1.35 | × 0.915 | 1.2353 |
| Total RVUs | 14.6160 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Kentucky$488.19
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 7.3 | 1 |
| Practice expense | 6.84 | 0.889 |
| Malpractice | 1.35 | 0.915 |
(7.3 × 1 + 6.84 × 0.889 + 1.35 × 0.915) × $33.4009 = $488.19
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.
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
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915
5607202,LA,01,NEW ORLEANS,1.000,0.941,1.136
5707202,LA,99,REST OF LOUISIANA,1.000,0.885,0.958
5814112,ME,03,SOUTHERN MAINE,1.000,0.991,0.631