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CPT code 11755: Nail biopsy, diagnostic tissue sampling2026 Medicare rate & RVUs in Delaware

Reports diagnostic tissue sampling from a nail unit when a nail plate, bed, or matrix abnormality requires examination.

CMS RVU26DEffective Oct 1, 2026One payment locality59.6K Medicare services in 2024

In Delaware, Medicare pays $118.51 for 11755 in the office and $54.16 when it’s performed in a hospital or facility.

$118.51Office (non-facility)
$54.16Hospital or facility
−0.9%vs the national office rate ($119.58)

Check a contract rate as a % of Medicare · 11755 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

We’ll open 11755 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Delaware
  2. What 11755 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

What 11755 covers

A clinician obtains tissue from a nail unit for diagnostic evaluation, such as when persistent nail dystrophy, an unexplained pigmented band, or a suspected nail-unit lesion needs assessment. Dermatologists, podiatrists, and other clinicians who treat nail disorders commonly perform the procedure in an office or procedural setting. The sampled structure may be the nail plate, bed, or matrix, depending on the abnormality and the diagnostic question.

Choose this service for tissue sampling, not routine trimming, debridement, or removal of a nail plate without a biopsy. Document the affected nail, the sampled nail-unit structure, the technique, and the clinical reason for obtaining tissue. The 0-day global period includes same-day preoperative and postoperative care. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

How Delaware compares for 11755

Across 109 of 109 payment localities, the office rate for 11755 runs from $107.20 in Arkansas to $155.57 in San Benito County, CA. Delaware pays $118.51. The RVUs are the same everywhere; the geographic indexes change the dollars.

11755 in Delaware vs other payment areas
  1. Delaware · this page$118.51
  2. Los Angeles, CA · California$133.76+$15.25
  3. Washington, DC area · District of Columbia$135.57+$17.06
  4. Miami, FL · Florida$128.27+$9.76
  5. Chicago, IL · Illinois$124.99+$6.48
  6. Manhattan, NY · New York$136.51+$18.00
  7. Alaska · Alaska$143.18+$24.67

Other areas in Delaware first, then benchmark localities. Bars start at $0.

Every other payment area

11755 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$108.59$51.60
ArkansasArkansas$107.20$51.25
ArizonaArizona$116.72$53.60
Bakersfield, CACalifornia$126.13$54.74
Chico, CACalifornia$125.78$54.39
El Centro, CACalifornia$125.80$54.41
Fresno, CACalifornia$125.78$54.39
Hanford, CACalifornia$125.78$54.39

11755 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$107.20

$143.18

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
11755 office rate range by state
State / territoryOffice rate rangeLocalities
AK$143.181
AL$108.591
AR$107.201
AZ$116.721
CA$125.78–$155.5729
CO$124.071
CT$126.951
DC$135.571
DE$118.511
FL$118.12–$128.273
GA$112.16–$121.642
GU$128.321
HI$128.321
IA$110.971
ID$111.631
IL$115.11–$124.994
IN$112.201
KS$110.541
KY$110.921
LA$110.78–$115.642
MA$123.46–$135.422
MD$120.58–$135.573
ME$112.17–$117.542
MI$113.51–$119.472
MN$119.171
MO$109.11–$115.983
MS$108.171
MT$119.571
NC$113.211
ND$117.391
NE$111.501
NH$122.201
NJ$128.48–$134.422
NM$114.081
NV$119.041
NY$114.73–$139.545
OH$113.071
OK$110.711
OR$118.18–$127.632
PA$113.21–$124.102
PR$120.351
RI$122.431
SC$113.311
SD$117.141
TN$111.041
TX$112.55–$123.608
UT$114.691
VA$117.22–$135.572
VI$120.351
VT$117.011
WA$123.21–$138.002
WI$113.881
WV$111.311
WY$118.621

See 11755 in every payment locality

How the 11755 rate is calculated

Each of 11755’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

How the rate is built · 11755

RVUs × geographic indexes × conversion factor

Office or facility?

Work1.22

1.22 RVUs× 1.000 GPCI

Practice expense2.25

2.25 RVUs× 1.000 GPCI

Malpractice0.11

0.11 RVUs× 1.000 GPCI

Adjusted RVUs

3.5800

Conversion factor

$33.4009

Medicare rate

$119.58

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Delaware inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

1,367

Code
11755
Physician work
1.22
Practice expense
2.25
Malpractice
0.11

GPCI2026.csv

40

Locality
Delaware
Physician work
1.005
Practice expense
0.988
Malpractice
0.899
Office calculation for 11755 in Delaware
ComponentRVULocality factorAdjusted
Physician work1.22× 1.0051.2261
Practice expense2.25× 0.9882.2230
Malpractice0.11× 0.8990.0989
Total RVUs3.5480
Conversion factor× 33.4009

Office rate, Delaware$118.51

Office: (1.22 × 1.005 + 2.25 × 0.988 + 0.11 × 0.899) × $33.4009 = $118.51

Facility: (1.22 × 1.005 + 0.3 × 0.988 + 0.11 × 0.899) × $33.4009 = $54.16

Open 11755 in the RVU calculator

Payment rules and modifiers for 11755

The CMS indicators that decide how 11755 is paid alongside other services.

CMS payment indicators · 11755

Nail biopsy, diagnostic tissue sampling

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)0Not paid without supporting documentation.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

11755 without 51 · national office

$119.58

Nail biopsy, diagnostic tissue sampling

11755-51 · Second procedure: 50%

$59.79

When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).

When to use modifier 51

Codes related to 11755

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 11755
CodeHow it relatesOffice range, Delaware
Used instead
11750Nail matrix excision, permanent partial or complete removalConsider for definitive nail or matrix excision rather than diagnostic tissue sampling.$156.22
11730Nail avulsion, single nail plateDescribes simple nail plate avulsion when plate removal, rather than biopsy, is the service.$110.56
11104Punch biopsy, single skin lesionSkin punch biopsy may fit a periungual skin lesion that does not involve the nail unit.$119.98

How 11755 has changed in Delaware

11755 · Office / nonfacility

$118.51

Effective 2026-10-01

The base rate is $1.16 higher than on 2025-10-01, moving from $117.35 to $118.51 (1.0%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $117.35changed to$118.51

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 1.25 changed to 1.22
    • Practice expense RVU 2.29 changed to 2.25
    • Malpractice RVU 0.10 changed to 0.11
    • Work GPCI 1.009 changed to 1.005
    • Practice expense GPCI 0.992 changed to 0.988
    • Malpractice GPCI 0.949 changed to 0.899

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $121.75changed to$117.35

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 2.32 changed to 2.29

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $119.76changed to$121.75

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $125.00changed to$119.76

    • Conversion factor 33.8872 changed to 32.7442
    • Work GPCI 1.007 changed to 1.009
    • Practice expense GPCI 1.007 changed to 0.992
    • Malpractice GPCI 0.938 changed to 0.949

  5. January 1, 2023

    RVU23A

    $128.73changed to$125.00

    • Conversion factor 34.6062 changed to 33.8872
    • Work GPCI 1.005 changed to 1.007
    • Practice expense GPCI 1.022 changed to 1.007
    • Malpractice GPCI 0.927 changed to 0.938

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $131.94changed to$128.73

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 2.38 changed to 2.32

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $127.19changed to$131.94

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 2.13 changed to 2.38
    • Malpractice RVU 0.09 changed to 0.10
    • Work GPCI 1.006 changed to 1.005
    • Practice expense GPCI 1.021 changed to 1.022
    • Malpractice GPCI 1.023 changed to 0.927

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $127.22changed to$127.19

    • Conversion factor 36.0391 changed to 36.0896
    • Work GPCI 1.007 changed to 1.006
    • Practice expense GPCI 1.019 changed to 1.021
    • Malpractice GPCI 1.119 changed to 1.023

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $137.36changed to$127.22

    • Conversion factor 35.9996 changed to 36.0391
    • Work RVU 1.31 changed to 1.25
    • Practice expense RVU 2.34 changed to 2.13
    • Malpractice RVU 0.10 changed to 0.09

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $138.25changed to$137.36

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 2.36 changed to 2.34
    • Work GPCI 1.010 changed to 1.007
    • Practice expense GPCI 1.025 changed to 1.019
    • Malpractice GPCI 1.101 changed to 1.119

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $138.83changed to$138.25

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 2.37 changed to 2.36
    • Work GPCI 1.012 changed to 1.010
    • Practice expense GPCI 1.031 changed to 1.025
    • Malpractice GPCI 1.083 changed to 1.101

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $138.96changed to$138.83

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 2.36 changed to 2.37

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $138.27changed to$138.96

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $137.96changed to$138.27

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 2.34 changed to 2.36
    • Malpractice RVU 0.11 changed to 0.10
    • Practice expense GPCI 1.038 changed to 1.031
    • Malpractice GPCI 0.878 changed to 1.083

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $140.33changed to$137.96

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 2.61 changed to 2.34
    • Practice expense GPCI 1.044 changed to 1.038
    • Malpractice GPCI 0.672 changed to 0.878

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $140.33

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$118.51$54.16RVU26D
2026-07-01$118.51$54.16RVU26C
2026-04-01$118.51$54.16RVU26B
2026-01-01$118.51$54.16RVU26A
2025-10-01$117.35$58.63RVU25D
2025-07-01$117.35$58.63RVU25C
2025-04-01$117.35$58.63RVU25B
2025-01-01$117.35$58.63RVU25A
2024-10-01$121.75$60.00RVU24D
2024-07-01$121.75$60.00RVU24C
2024-04-01$121.75$60.00RVU24B
2024-03-09$121.75$60.00RVU24AR
2024-01-01$119.76$59.02RVU24A
2023-10-01$125.00$60.85RVU23D
2023-07-01$125.00$60.85RVU23C
2023-04-01$125.00$60.85RVU23B
2023-01-01$125.00$60.85RVU23A
2022-10-01$128.73$61.54RVU22D
2022-07-01$128.73$61.54RVU22C
2022-04-01$128.73$61.54RVU22B
2022-01-01$128.73$61.54RVU22A
2021-10-01$131.94$62.40RVU21D
2021-07-01$131.94$62.40RVU21C
2021-04-01$131.94$62.40RVU21B
2021-01-01$131.94$62.40RVU21A
2020-10-01$127.19$64.92RVU20D
2020-07-01$127.19$64.92RVU20C
2020-04-01$127.19$64.92RVU20B
2020-01-01$127.19$64.92RVU20A
2019-10-01$127.22$65.52RVU19D
2019-07-01$127.22$65.52RVU19C
2019-04-01$127.22$65.52RVU19B
2019-01-01$127.22$65.52RVU19A
2018-10-01$137.36$80.86RVU18D
2018-07-01$137.36$80.86RVU18C
2018-04-01$137.36$80.86RVU18B
2018-01-01$137.36$80.86RVU18AR1
2017-10-01$138.25$81.23RVU17D
2017-07-01$138.25$81.23RVU17C
2017-04-01$138.25$81.23RVU17B
2017-01-01$138.25$81.23RVU17A
2016-10-01$138.83$81.61RVU16D
2016-07-01$138.83$81.61RVU16C
2016-04-01$138.83$81.61RVU16B
2016-01-01$138.83$81.61RVU16A
2015-10-01$138.96$81.54RVU15D
2015-07-01$138.96$81.54RVU15C
2015-04-01$138.27$81.13RVU15B
2015-01-01$138.27$81.13RVU15A
2014-10-01$137.96$81.44RVU14D
2014-07-01$137.96$81.44RVU14C
2014-04-01$137.96$81.44RVU14B
2014-01-01$137.96$81.44RVU14A
2013-10-01$140.33$79.59RVU13D
2013-07-01$140.33$79.59RVU13C
2013-04-01$140.33$79.59RVU13B
2013-01-01$140.33$79.59RVU13AR

Price 11755 for an earlier date of service

Where the Delaware rate applies

Delaware is a Medicare payment area, not a city. Our Census mapping connects it to 79 cities and communities in Delaware. Some span more than one payment area; confirm with the service ZIP.

  • Arden
  • Ardencroft
  • Ardentown
  • Bear
  • Bellefonte
  • Bethany Beach
  • Bethel
  • Blades

Browse all communities in Delaware

11755 billing questions

When is this reported instead of nail avulsion?

Report 11755 when tissue is sampled for diagnosis. Nail plate removal alone, without diagnostic tissue sampling, is a different service.

Is routine nail debridement included as a biopsy?

No. Trimming or debriding dystrophic nails is not diagnostic tissue sampling; 11755 requires a biopsy of the nail unit.

What documentation supports the service?

Record the affected nail, the nail-unit structure sampled, the method used, and the clinical finding or diagnostic concern prompting the biopsy.

Can modifier 50 be used when both sides are treated?

No. CMS identifies the bilateral adjustment as inapplicable and modifier 50 as inappropriate for this service.

How does the 0-day global period affect same-day care?

Same-day preoperative and postoperative care is included in the procedure's payment.

Can an assistant or another surgeon be reported?

Assistant-at-surgery payment requires documentation of medical necessity. Co-surgeons and team surgery are not permitted.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Show the CMS file lines behind this rate
RVUs for 11755PPRRVU2026_Oct_nonQPP.csv, line 1,367 (RVU26D)
Geographic factors for DelawareGPCI2026.csv, line 40 (RVU26D)

Open CMS sourceHow we calculate rates

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