Fee Navigator®

    Health Service Code 97.96

    Removal of tissue expander for breast reconstruction

    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:$141.17

    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$112.29
    ROLEANESTYesReplace Base$18.70
    ANUANU1For Each Call Pay Base At100%
    ANUANU2 - 150For Each Call Increase By$18.70
    UGAUGAYesReplace Base$134.85
    CALLNBRSER1For Each Call Pay Base At100%
    CALLNBRSER2 - 2For Each Call Pay Base At75%
    SURCEVYesIncrease By$48.82
    SURCNTAMYesIncrease By$117.12
    SURCNTPMYesIncrease By$117.12
    SURCWKYesIncrease By$48.82

    Governing Rules: