2025 CPT code 11981
(Active) Effective Date: N/A Revision Date: N/A Surgery - Introduction or Removal Procedures on the Integumentary System Surgery Feed
Insertion of a non-biodegradable drug delivery implant.
Modifiers 25 (significant, separately identifiable E/M service), 50 (bilateral procedure), and 51 (multiple procedures) may be applicable depending on the circumstances.Additional modifiers may apply; refer to the CPT manual and payer guidelines.
Medical necessity must be established for long-term drug delivery via this method.Documentation should justify why oral or other less invasive routes of medication administration are inadequate. This justification should be based on the patient's specific clinical condition and needs.
The provider is responsible for administering anesthesia (if necessary), creating a small incision, inserting the drug-delivery implant, and closing the incision.The provider's expertise should align with the specific requirements of the implant used.
- Surgery
- Surgical Procedures on the Integumentary System > Introduction or Removal Procedures on the Integumentary System
In simple words: The doctor places a small, slow-release capsule or pellet under your skin to deliver medicine over time. This might be used for antibiotics, birth control, or pain medication.The capsule doesn't dissolve in your body.
This CPT code reports the insertion of a non-biodegradable drug delivery implant (capsule or pellet) containing medication for long-term release.The procedure may involve administering anesthesia, creating a small subcutaneous incision (often in the arm), inserting the implant, and closing the incision. The implant acts as a reservoir for the continuous release of drugs such as antibiotics, contraceptives, or opioids.The implant itself is not bioresorbable or biodegradable.
Example 1: A patient requires long-term antibiotic therapy for osteomyelitis.A slow-release antibiotic implant is inserted subcutaneously., A woman opts for long-acting contraception. A subdermal implant containing a contraceptive hormone is inserted in her arm., A patient with chronic pain receives a subcutaneous implant releasing an opioid analgesic for extended pain management.
Detailed documentation should include the type of implant used (manufacturer, model number), the medication contained within the implant, the location of insertion, the technique used (including anesthesia if administered), and the amount of medication released.Pre-operative and post-operative notes, including any complications or adverse events, are also essential.
** Always verify the correct code and any applicable modifiers with the payer before submitting a claim.The reimbursement rate will vary depending on the payer and geographic location.Consider the use of more specific codes if applicable. Note that CPT codes do not include the cost of the implant itself; this should be billed separately using a HCPCS code.
- Revenue Code: P6D (MINOR PROCEDURES - OTHER (NON-MEDICARE FEE SCHEDULE))
- RVU: This information is not provided in the source, but can be found in the Medicare Physician Fee Schedule (MPFS) and may vary by location. Consult your local Medicare Administrative Contractor (MAC).
- Global Days : The global period is not explicitly defined for this code in the provided sources.Further clarification may be needed from the payer or official CPT guidelines.
- Payment Status: Active
- Modifier TC rule: A technical component (TC) modifier is not typically applicable to this code, as it represents the entire procedure of implant insertion.
- Fee Schedule : Fee schedule information is not provided but can be obtained through the Medicare Physician Fee Schedule or other relevant payers.
- Specialties:General Surgery, Plastic Surgery, Orthopedic Surgery (in specific circumstances), Pain Management
- Place of Service:Office, Ambulatory Surgical Center, Hospital (Inpatient or Outpatient)