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See a sample rate comparisonCPT 11960 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
Insrt Of Tissue Expander(S) For Other Than Breast Inclu Subse, Insertion Of Tissue Expander(S) For Other Than Breast Including Subse
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Integumentary System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 21 - Inpatient Hospital |
| Common Modifiers | None 58 - Staged or related procedure during postoperative period 59 - Distinct Procedural Service |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 11960 |
| Medicaid Fee Schedule | View Medicaid rates for 11960 |
National average reimbursement for CPT 11960 by major payers:
$1,267.96
$1,219.57
$1,279.48
$1,594.65
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CPT 11960
5 of 25 sample ratesHigher to lower in this preview
Pinnacle Surgery Center, Inc
Pinnacle Surgery Center Inc
$12,000.00Published rateMcallen Surgicenter, LLC, Mcallen Surgery Center
Mcallen Surgicenter LLC
$3,632.00Published rateEhi Surgery Center Austin, LLC
Ehi Surgery Center Austin LLC
$2,277.00Published rateJohns Hopkins Surgery Centers Series
Johns Hopkins Surgery Center Series
$1,685.00Published rateCoffee County Center For Digestive Diseases LLC
$734.00Published rate
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See a sample payer proposalCPT 11960 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 11960 code is part of the Surgery services used for Surgical Procedures on the Integumentary System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 11960 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 11960-CPT | High | Insrt Of Tissue Expander(S) For Other Than Breast Inclu Subse, Insertion Of Tissue Expander(S) For Other Than Breast Including Subse |
| 11970-CPT | Moderate | Skin Prosthesis Placement, Surgery To Place A Permanent Prosthesis (Structure) Where A Tissue Expander Has Been Used To Prepare Tissue To Accept The Prosthesis. |
| 11971-CPT | Moderate | Removal Of Tissue Expander, Surgery To Remove A Tissue Expander Without Replacing It With A Prosthesis (Structure). |
| 11981-CPT | Low | Implant Drug Delivery Unit, Procedure To Implant (Insert Under The Skin) A Nonbiodegradable Device That Dispenses A Drug Automatically. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 11960. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 11960 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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