Billing code 11981: Drug implant insertionMedicare rate & RVUs in Washington
Report 11981 for inserting a non-biodegradable drug delivery implant, such as a subdermal contraceptive implant placed in the upper arm.
Medicare pays $109.72–$122.53 for 11981 in the office in Washington, from Rest Of Washington to Seattle (King Cnty). Which amount applies depends on the service address.
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 11981 covers
Code 11981 describes the procedure to place a non-biodegradable implant that releases medication over time. A common example is insertion of an etonogestrel contraceptive implant beneath the skin of the upper arm. The service is typically performed in an office or other outpatient setting by a physician or other qualified clinician. The implant product is distinct from the insertion procedure; for an etonogestrel contraceptive implant, the product may be reported with HCPCS code J7307 when applicable.
Report the insertion when the implant is placed, and document the medication or implant, insertion site, and completed procedure. This is a minor procedure with a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate for this service. Assistant-at-surgery payment requires documentation of 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 11981 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | $109.72 | $54.15 |
| Seattle (King Cnty) | $122.53 | $57.77 |
How the 11981 rate is calculated
Each of 11981’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 · 11981
RVUs × geographic indexes × conversion factor
Work1.11
1.11 RVUs× 1.000 GPCI
Practice expense1.90
1.90 RVUs× 1.000 GPCI
Malpractice0.21
0.21 RVUs× 1.000 GPCI
Adjusted RVUs
3.2200
Conversion factor
$33.4009
Medicare rate
$107.55
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 11981
The CMS indicators that decide how 11981 is paid alongside other services.
CMS payment indicators · 11981
Drug implant insertion
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| 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. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
11981 without 51 · national office
$107.55
Drug implant insertion
11981-51 · Second procedure: 50%
$53.78
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
11981 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 11980Hormone pellets
- Use 11980 for insertion of hormone pellets. Use 11981 for a non-biodegradable drug delivery implant, such as an etonogestrel contraceptive implant.
- 11982Implant removal
- 11982 reports removal of a drug implant device. It does not describe placing an implant.
- 11983Drug implant
- 11983 describes removal of an existing drug implant followed by insertion of a replacement. Use 11981 when the service is insertion without that removal-and-reinsertion sequence.
11981 billing questions
How does 11981 differ from 11980?
11981 is for inserting a non-biodegradable drug delivery implant, such as an etonogestrel contraceptive implant. 11980 describes insertion of hormone pellets.
Should the implant product be reported separately?
The insertion procedure and the drug implant product are distinct. For an etonogestrel contraceptive implant, HCPCS J7307 may report the product when applicable.
Is modifier 50 appropriate for two implants?
No. CMS identifies modifier 50 as inappropriate for 11981. Report the insertion service based on the procedure performed rather than billing it as a bilateral service.
What documentation supports 11981?
Document the implant or medication used, the insertion site, and that the implant was placed. For an upper-arm contraceptive implant, the record should support the completed insertion.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction when performed in the same session.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment is allowed only when medical necessity is documented. Co-surgeons and team surgery are not permitted 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
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