2025 CPT code 11960
(Active) Effective Date: N/A Surgery - Surgical Procedures on the Integumentary System Feed
Insertion of tissue expander(s) for other than breast, including subsequent expansion.
Modifiers such as 22 (Increased Procedural Services), 51 (Multiple Procedures), 59 (Distinct Procedural Service), 78 (Return to the Operating Room), and others may be applicable depending on the specific circumstances.
Medical necessity should be established by documenting the defect requiring repair, the inadequacy of existing tissue for reconstruction, and how tissue expansion will facilitate the definitive reconstructive procedure.
The physician is responsible for prepping and anesthetizing the patient, making the incision, inserting the tissue expander, closing the incision, and managing the subsequent expansion of the expander with saline. They must also monitor the patient for complications and ensure appropriate healing.
In simple words: A surgeon places a temporary implant under the skin to help stretch and grow new tissue. This is done to prepare for reconstructive surgery in areas of the body other than the breast. The implant is gradually filled with saline to expand the skin and encourage tissue growth.
The provider inserts one or more implants under the patient’s skin that helps to expand the tissues. This code represents placement of expanders anywhere in the patient’s body, except the breast, for reconstruction of tissue defects.The procedure involves making an incision, inserting the tissue expander, closing the skin, and subsequently expanding the expander with saline solution over time.This promotes tissue growth for later surgical use, such as skin flaps.This code includes subsequent expansion by saline.
Example 1: A patient with a large burn scar on their back requires skin grafting. A tissue expander is inserted under the skin near the scar to grow additional skin for the graft., Following removal of a tumor on the scalp, a tissue expander is placed to create enough skin to close the surgical defect., A patient with a congenital hand defect requires additional skin and soft tissue to reconstruct the hand.A tissue expander is inserted in the forearm to create the needed tissue.
Documentation should include the location of the tissue expander insertion, the size and type of expander used, the reason for the expansion, operative details, and any complications encountered.Photographs may be helpful for pre and postoperative comparisons.
** For replacement of a tissue expander with a permanent implant, use 11970. For removal of a tissue expander without placement of a permanent implant, use 11971.
- Revenue Code: P1G - MAJOR PROCEDURE - OTHER
- Global Days: Global Days: Refer to current CMS guidelines for global days associated with 11960.
- Specialties:Plastic Surgery, Reconstructive Surgery, General Surgery,and potentially other surgical specialties depending on the area of the body being treated.
- Place of Service:Ambulatory Surgical Center, Hospital - Inpatient, Hospital - Outpatient, Office