Fee Navigator

    Health Service Code 97.96

    Removal of tissue expander for breast reconstruction

    NOTE:
    1. When removal is the only procedure performed and not part of another procedure.
    2. Bilateral procedures may be claimed using 2 calls.
    Category:1 Major Procedure (pre-operative period: 0 days, post-operative period: 14 days)
    Base rate:$140.96

    AMA billing tips:

    • Tissue expanders either removal or insertion within the inclusive care period may not be claimed.

      Tissue expander removal or insertion outside of the inclusive care period may be claimed as a visit.

      Inclusive care period refers to the number of days before and after a procedure whereby all visit services (except consultations) are considered to be part of the surgical benefit.

    Fee modifiers:

    TypeCode# of callsExplicitActionAmount
    BMIBMIANEYesIncrease By25%
    BMIBMIANTYesIncrease By25%
    BMIBMIPROYesIncrease By25%
    ROLEANEYesReplace Base$110.43
    ROLEANESTYesReplace Base$18.39
    ANUANU1For Each Call Pay Base At100%
    ANUANU2 - 150For Each Call Increase By$18.39
    UGAUGAYesReplace Base$134.85
    CALLNBRSER1For Each Call Pay Base At100%
    CALLNBRSER2 - 2For Each Call Pay Base At75%
    SURCEVYesIncrease By$48.70
    SURCNTAMYesIncrease By$116.83
    SURCNTPMYesIncrease By$116.83
    SURCWKYesIncrease By$48.70

    Governing Rules: