CPT code 11755: Nail biopsy, diagnostic tissue sampling2026 Medicare rate & RVUs in Texas
Reports diagnostic tissue sampling from a nail unit when a nail plate, bed, or matrix abnormality requires examination.
Medicare pays $112.55–$123.60 for 11755 in the office in Texas, from Beaumont, TX to Austin, TX. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
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.
Where 11755 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 payment localities
$112.55 to $123.60
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin, TX | $123.60 | $54.69 |
| Beaumont, TX | $112.55 | $53.28 |
| Brazoria, TX | $118.42 | $53.87 |
| Dallas, TX | $119.12 | $54.25 |
| Fort Worth, TX | $118.42 | $54.20 |
| Galveston, TX | $118.74 | $54.07 |
| Houston, TX | $120.76 | $56.08 |
| Rest of Texas | $115.39 | $53.58 |
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
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.
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
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician 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%).
11755 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 11750Nail matrix excisionPermanent partial or complete removal
- 11755 obtains tissue for diagnosis; 11750 is used for excision of the nail and matrix as a therapeutic procedure.
- 11730Nail avulsionSingle nail plate
- 11730 reports simple removal of a nail plate. Use 11755 when tissue from the nail unit is sampled for diagnostic evaluation.
- 11104Punch biopsySingle skin lesion
- 11104 describes a punch biopsy of skin. Use 11755 when the sampled structure is part of the nail unit rather than periungual skin alone.
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
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