CPT 11970 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Surgery • Surgical Procedures on the Integumentary System |
| Common Place of Service | • 22 - On Campus Outpatient Hospital • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • 50 - Bilateral Procedure • RT - Right side of body |
| Complexity Level | Moderate |
National average reimbursement for CPT 11970 by major payers:
$760.30
$779.08
$800.09
$966.20
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 11970 | ||||||
United | 11970 | $1907.00 | 1932390234 - RENO ORTHOPAEDIC SURGERY CENTER LLC | 208256389 - (NV) RENO ORTHOPAEDIC SURGERY CENTER LLC | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11970 | $4704.00 | 1154844553 - LONE STAR ENDOSCOPY CENTER, LLC, LONE STAR ENDOSCOPY SOUTHLAKE | 273635726 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11970 | $5354.00 | 1790093813 - AZ WEST ENDOSCOPY CENTER LLC | 272343469 - (AZ) AZ WEST ENDOSCOPY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11970 | $963.00 | 1639142706 - AMBULATORY SURGERY CENTER LLC, AMBULATORY SURGERY CENTER | 311545306 - (KY) AMBULATORY SURGERY CENTER LLC | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11970 | $8238.00 | 1366047433 - MANSFIELD ENDOSCOPY CENTER, LLC | 861354607 - (TX) MANSFIELD ENDOSCOPY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11970 | $5354.00 | 1285215301 - LAKEWOOD RANCH SURGICAL SUITES, LLC | 842624445 - (FL) LAKEWOOD RANCH SURGICAL SUITES LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11970 | $2700.00 | 1275132094 - COASTAL CARDIOVASCULAR CENTER, LLC, COASTAL CARDIOVASCULAR CENTER | 845144651 - (TX) COASTAL CARDIOVASCULAR CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11970 | $7485.00 | 1386028439 - JOHNSTON MEMORIAL HOSPITAL, INC, JOHNSTON MEMORIAL SURGERY CENTER | 540544705 - JOHNSTON MEMORIAL HOSPITAL INC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11970 | $3314.00 | 1124594338 - CHARLOTTE SURGERY CENTER, LLC | 561449531 - (NC) CHARLOTTE SURGERY CENTER LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11970 | $4074.00 | 1013136456 - SOUTH JERSEY MUSCULOSKELETAL INSTITUTE, LLC, ADVANCED SURGICAL INSTITUTE | 204481032 - (NJ) SOUTH JERSEY MUSCULOSKELETAL INSTITUTE, LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11970 | $853.00 | 1770557233 - MESA AZ ENDOSCOPY ASC LLC, DESERT ENDOSCOPY CENTER | 510426858 - (AZ) THE MESA AZ ENDOSCOPY ASC, LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11970 | $10779.00 | 1104996768 - GREATER DAYTON SURGERY CENTER LLC | 202913367 - (OH) GREATER DAYTON SURGERY CENTER | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11970 | $1065.07 | 1588875231 - DEEPA GHANTA | 350593390 - DEACONESS HOSPITAL INC | IN | Hospitalist Physician (208M00000X) |
United | 11970 | $2134.00 | 1386737021 - ARKANSAS OUTPATIENT EYE SURGERY LLC, MCDONALD EYE ASSOCIATES SURGERY AND LASIK CENTER | 752777970 - (AR) ARKANSAS OUTPATIENT EYE SURGERY LLC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 11970 | $774.00 | 1194999359 - JEFFREY L BOBER DPM PA, JEFFREY L BOBER DPM PA ASC | 521706931 - (MD) JEFFREY L BOBER DPM PA | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
Want to see your competitors' rates?
Start your trial today to unlock complete access to provider rates and fee schedules in your area.
Here's what you can do with PayerPrice
Renegotiate your managed care contracts
Benchmark your current rates against market averages to identify opportunities for rate optimization.
Prospect for new business using fee schedules
Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.
Integrate real-time payer data into your workflows
Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.
PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.
CPT 11970 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 11970 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 11970 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 | Insertion Tissue Expander |
| 11970-CPT | Moderate | Replacement Of Tissue Expander With Permanent Implant (Desc Rvsd 1/1/21) |
| 11971-CPT | Moderate | Removal Of Tissue Expander(S) Without Insertion Of Implant (Desc Rvsd 1/1/21) |
| 11981-CPT | Low | Insertion Drug Delivery Implant(Ie Bioresorbable Biodegradable Non-Biodegradable) (Desc Rvsd 1/1/22) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 11970. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 11970 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.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 11970) and we'll show you how you compare in 15 minutes or less.