Billing code 11970: Implant exchangeMedicare rate & RVUs in Nevada
Reports exchange of a tissue expander for a permanent implant, commonly during the later stage of breast reconstruction after mastectomy.
CMS doesn’t publish an office rate for 11970 in Nevada.
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 11970 covers
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.
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 in Nevada**
| Payment locality | Office | Facility |
|---|---|---|
| Nevada** | Unavailable | $510.08 |
How the 11970 rate is calculated
Each of 11970’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 · 11970
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 7.30Practice expense 6.84Malpractice 1.35
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 11970
11970 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 11970
Implant exchange
| 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) | 1 | Not paid (statutory restriction). |
| 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 · 11970
Implant exchange
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
11970 without 50 · national facility
$517.38
Implant exchange
11970-50 · Bilateral: 150%
$776.07
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).
11970 compared with similar codes
Compare codes
11970 vs 11960 vs 11971 vs 19342: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 11960Tissue expander
- Use 11960 for insertion of a tissue expander. Use 11970 when the procedure exchanges an existing expander for a permanent implant.
- 11971Expander removal
- 11971 describes removal of a tissue expander without implant insertion; 11970 describes an exchange that includes permanent implant placement.
- 19342Breast implant
- 19342 covers breast implant insertion or replacement on a separate day from mastectomy. 11970 specifically describes exchanging a tissue expander for a permanent implant.
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 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
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