CPT code 11765: Nail-fold excision, skin fold only2026 Medicare rate & RVUs in Montana
Report this procedure when a clinician surgically removes a wedge of skin from a nail fold, commonly to treat an ingrown nail.
In Montana, Medicare pays $162.99 for 11765 in the office and $89.17 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 11765 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
What 11765 covers
A clinician removes a wedge of skin from the nail fold, often to address an ingrown nail with painful or inflamed tissue along the nail edge. The service targets the surrounding skin fold; it is distinct from removing the nail plate or excising the nail matrix. It is commonly performed by a physician or other qualified practitioner in an office or outpatient procedure setting.
Select the code when the operative note supports excision of nail-fold skin, rather than nail trimming, nail avulsion alone, or nail-matrix removal. Document the affected nail, the fold tissue excised, and the reason for the procedure. Medicare assigns a 10-day global period, so related postoperative visits during that period are included. 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. Medicare does not pay an assistant at surgery for this code; 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 Montana compares for 11765
Across 109 of 109 payment localities, the office rate for 11765 runs from $144.58 in Arkansas to $219.12 in San Benito County, CA. Montana pays $162.99. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Montana · this page$162.99
- Los Angeles, CA · California$185.62+$22.63
- Washington, DC area · District of Columbia$186.89+$23.90
- Miami, FL · Florida$172.52+$9.53
- Chicago, IL · Illinois$167.77+$4.78
- Manhattan, NY · New York$186.78+$23.79
- Alaska · Alaska$189.34+$26.35
Other areas in Montana first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $146.66 | $82.07 |
| ArkansasArkansas | $144.58 | $81.18 |
| ArizonaArizona | $158.84 | $87.31 |
| Bakersfield, CACalifornia | $174.12 | $93.22 |
| Chico, CACalifornia | $173.82 | $92.92 |
| El Centro, CACalifornia | $173.84 | $92.93 |
| Fresno, CACalifornia | $173.82 | $92.92 |
| Hanford, CACalifornia | $173.82 | $92.92 |
| Madera, CACalifornia | $173.82 | $92.92 |
| Merced, CACalifornia | $173.82 | $92.92 |
| Modesto, CACalifornia | $173.82 | $92.92 |
| Napa, CACalifornia | $202.26 | $104.97 |
| Oxnard, CACalifornia | $184.86 | $97.61 |
| Redding, CACalifornia | $173.82 | $92.92 |
| Rest of CaliforniaCalifornia | $173.82 | $92.92 |
| Riverside, CACalifornia | $174.81 | $93.91 |
| Sacramento, CACalifornia | $182.63 | $96.78 |
| Salinas, CACalifornia | $181.95 | $96.40 |
| San Diego, CACalifornia | $186.38 | $98.10 |
| Marin County, CACalifornia | $214.45 | $110.37 |
| San Francisco, CACalifornia | $214.34 | $110.26 |
| San Benito County, CACalifornia | $219.12 | $112.68 |
| Santa Clara County, CACalifornia | $218.70 | $112.26 |
| San Luis Obispo, CACalifornia | $178.99 | $94.91 |
| Santa Cruz, CACalifornia | $188.29 | $98.60 |
| Santa Maria, CACalifornia | $182.67 | $96.61 |
| Santa Rosa, CACalifornia | $190.21 | $99.56 |
| Stockton, CACalifornia | $173.82 | $92.92 |
| Vallejo, CACalifornia | $202.11 | $104.82 |
| Visalia, CACalifornia | $173.82 | $92.92 |
| Yuba City, CACalifornia | $173.82 | $92.92 |
| ColoradoColorado | $170.51 | $91.97 |
| ConnecticutConnecticut | $173.68 | $94.18 |
| DelawareDelaware | $161.45 | $88.52 |
| Fort Lauderdale, FLFlorida | $166.99 | $92.21 |
| Rest of FloridaFlorida | $159.22 | $88.65 |
| Atlanta, GAGeorgia | $165.64 | $90.65 |
| Rest of GeorgiaGeorgia | $150.59 | $84.74 |
| Hawaii, Guam, HIHawaii | $178.20 | $94.28 |
| IowaIowa | $150.96 | $83.42 |
| IdahoIdaho | $151.79 | $83.88 |
| East St. Louis, ILIllinois | $156.43 | $88.51 |
| Rest of IllinoisIllinois | $154.23 | $86.83 |
| Suburban Chicago, ILIllinois | $168.84 | $93.03 |
| IndianaIndiana | $152.67 | $84.25 |
| KansasKansas | $149.96 | $83.23 |
| KentuckyKentucky | $149.39 | $83.77 |
| New Orleans, LALouisiana | $156.31 | $86.85 |
| Rest of LouisianaLouisiana | $149.04 | $83.72 |
| Metropolitan Boston, MAMassachusetts | $187.62 | $99.49 |
| Rest of MassachusettsMassachusetts | $169.40 | $91.67 |
| Baltimore area, MDMaryland | $173.12 | $93.92 |
| Rest of MarylandMaryland | $164.59 | $89.89 |
| Rest of MaineMaine | $152.24 | $84.33 |
| Southern Maine, MEMaine | $160.80 | $87.65 |
| Detroit, MIMichigan | $160.85 | $89.62 |
| Rest of MichiganMichigan | $152.92 | $85.53 |
| MinnesotaMinnesota | $164.37 | $88.41 |
| Metropolitan Kansas City, MOMissouri | $155.59 | $86.28 |
| Metropolitan St. Louis, MOMissouri | $157.23 | $86.96 |
| Rest of MissouriMissouri | $146.32 | $82.70 |
| MississippiMississippi | $145.50 | $81.94 |
| North CarolinaNorth Carolina | $153.85 | $84.98 |
| North DakotaNorth Dakota | $161.21 | $87.39 |
| NebraskaNebraska | $151.87 | $83.74 |
| New HampshireNew Hampshire | $167.55 | $90.71 |
| Northern New JerseyNew Jersey | $184.94 | $99.32 |
| Rest of New JerseyNew Jersey | $175.94 | $95.33 |
| New MexicoNew Mexico | $153.62 | $85.93 |
| NevadaNevada | $162.61 | $88.72 |
| NYC suburbs and Long Island, NYNew York | $190.84 | $103.08 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $176.84 | $96.01 |
| Queens, NYNew York | $188.75 | $101.50 |
| Rest of New YorkNew York | $156.09 | $85.97 |
| OhioOhio | $152.56 | $85.17 |
| OklahomaOklahoma | $149.46 | $83.54 |
| Portland, OROregon | $176.21 | $94.20 |
| Rest of OregonOregon | $161.62 | $88.10 |
| Metropolitan Philadelphia, PAPennsylvania | $169.22 | $92.38 |
| Rest of PennsylvaniaPennsylvania | $152.97 | $85.21 |
| Puerto RicoPuerto Rico | $164.27 | $89.65 |
| Rhode IslandRhode Island | $167.39 | $91.14 |
| South CarolinaSouth Carolina | $153.41 | $85.20 |
| South DakotaSouth Dakota | $161.00 | $87.18 |
| TennesseeTennessee | $150.66 | $83.56 |
| Austin, TXTexas | $169.71 | $91.61 |
| Beaumont, TXTexas | $151.96 | $84.79 |
| Brazoria, TXTexas | $161.57 | $88.42 |
| Dallas, TXTexas | $162.45 | $88.93 |
| Fort Worth, TXTexas | $161.28 | $88.50 |
| Galveston, TXTexas | $161.96 | $88.66 |
| Houston, TXTexas | $163.60 | $90.30 |
| Rest of TexasTexas | $156.57 | $86.52 |
| UtahUtah | $155.48 | $86.09 |
| VirginiaVirginia | $160.07 | $87.51 |
| Virgin Islands, VIUnited States Virgin Islands | $164.27 | $89.65 |
| VermontVermont | $160.31 | $87.23 |
| Rest of WashingtonWashington | $169.17 | $91.44 |
| King County, WAWashington | $191.73 | $101.16 |
| WisconsinWisconsin | $155.87 | $85.15 |
| West VirginiaWest Virginia | $148.54 | $84.39 |
| WyomingWyoming | $162.21 | $88.40 |
11765 rates by state
Office rate range in each state. Select a state to see its payment localities.
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.
$144.58
$196.47
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $189.34 | 1 |
| AL | $146.66 | 1 |
| AR | $144.58 | 1 |
| AZ | $158.84 | 1 |
| CA | $173.82–$219.12 | 29 |
| CO | $170.51 | 1 |
| CT | $173.68 | 1 |
| DC | $186.89 | 1 |
| DE | $161.45 | 1 |
| FL | $159.22–$172.52 | 3 |
| GA | $150.59–$165.64 | 2 |
| GU | $178.20 | 1 |
| HI | $178.20 | 1 |
| IA | $150.96 | 1 |
| ID | $151.79 | 1 |
| IL | $154.23–$168.84 | 4 |
| IN | $152.67 | 1 |
| KS | $149.96 | 1 |
| KY | $149.39 | 1 |
| LA | $149.04–$156.31 | 2 |
| MA | $169.40–$187.62 | 2 |
| MD | $164.59–$186.89 | 3 |
| ME | $152.24–$160.80 | 2 |
| MI | $152.92–$160.85 | 2 |
| MN | $164.37 | 1 |
| MO | $146.32–$157.23 | 3 |
| MS | $145.50 | 1 |
| MT | $162.99 | 1 |
| NC | $153.85 | 1 |
| ND | $161.21 | 1 |
| NE | $151.87 | 1 |
| NH | $167.55 | 1 |
| NJ | $175.94–$184.94 | 2 |
| NM | $153.62 | 1 |
| NV | $162.61 | 1 |
| NY | $156.09–$190.84 | 5 |
| OH | $152.56 | 1 |
| OK | $149.46 | 1 |
| OR | $161.62–$176.21 | 2 |
| PA | $152.97–$169.22 | 2 |
| PR | $164.27 | 1 |
| RI | $167.39 | 1 |
| SC | $153.41 | 1 |
| SD | $161.00 | 1 |
| TN | $150.66 | 1 |
| TX | $151.96–$169.71 | 8 |
| UT | $155.48 | 1 |
| VA | $160.07–$186.89 | 2 |
| VI | $164.27 | 1 |
| VT | $160.31 | 1 |
| WA | $169.17–$191.73 | 2 |
| WI | $155.87 | 1 |
| WV | $148.54 | 1 |
| WY | $162.21 | 1 |
How the 11765 rate is calculated
Each of 11765’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 · 11765
RVUs × geographic indexes × conversion factor
Work1.19
1.19 RVUs× 1.000 GPCI
Practice expense3.60
3.60 RVUs× 1.000 GPCI
Malpractice0.09
0.09 RVUs× 1.000 GPCI
Adjusted RVUs
4.8800
Conversion factor
$33.4009
Medicare rate
$163.00
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Montana inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
1,371
- Code
- 11765
- Physician work
- 1.19
- Practice expense
- 3.60
- Malpractice
- 0.09
GPCI2026.csv
71
- Locality
- Montana
- Physician work
- 1.000
- Practice expense
- 1.000
- Malpractice
- 0.998
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.19 | × 1.000 | 1.1900 |
| Practice expense | 3.60 | × 1.000 | 3.6000 |
| Malpractice | 0.09 | × 0.998 | 0.0898 |
| Total RVUs | 4.8798 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Montana$162.99
Office: (1.19 × 1 + 3.6 × 1 + 0.09 × 0.998) × $33.4009 = $162.99
Facility: (1.19 × 1 + 1.39 × 1 + 0.09 × 0.998) × $33.4009 = $89.17
Payment rules and modifiers for 11765
11765 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 11765
Nail-fold excision, skin fold only
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 days after are 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) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 11765
Nail-fold excision, skin fold only
10-day global period ends
Oct 11, 2026
Covers Oct 1, 2026 through Oct 11, 2026 (11 days).
Visit on Oct 31, 2026
After the global period ends: visits and procedures are billed normally.
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
11765 without 51 · national office
$163.00
Nail-fold excision, skin fold only
11765-51 · Second procedure: 50%
$81.50
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%).
How 11765 has changed in Montana
11765 · Office / nonfacility
$162.99
Effective 2026-10-01
The base rate is $3.27 higher than on 2025-10-01, moving from $159.72 to $162.99 (2.0%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
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
January 1, 2026
RVU26A
$159.72changed to$162.99
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 1.22 changed to 1.19
- Practice expense RVU 3.62 changed to 3.60
- Malpractice RVU 0.10 changed to 0.09
- Malpractice GPCI 0.978 changed to 0.998
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$166.36changed to$159.72
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 3.68 changed to 3.62
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$163.65changed to$166.36
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$167.67changed to$163.65
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 3.63 changed to 3.68
January 1, 2023
RVU23A
$171.22changed to$167.67
- Conversion factor 34.6062 changed to 33.8872
- Malpractice GPCI 0.977 changed to 0.978
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$174.04changed to$171.22
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 3.67 changed to 3.63
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$174.22changed to$174.04
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 3.49 changed to 3.67
- Malpractice RVU 0.09 changed to 0.10
- Malpractice GPCI 1.304 changed to 0.977
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$175.03changed to$174.22
- Conversion factor 36.0391 changed to 36.0896
- Malpractice GPCI 1.631 changed to 1.304
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$173.76changed to$175.03
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 3.46 changed to 3.49
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$171.50changed to$173.76
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 3.43 changed to 3.46
- Malpractice GPCI 1.429 changed to 1.631
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$170.08changed to$171.50
- Conversion factor 35.8043 changed to 35.8887
- Practice expense RVU 3.42 changed to 3.43
- Malpractice GPCI 1.226 changed to 1.429
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$170.70changed to$170.08
- Conversion factor 35.9335 changed to 35.8043
Held through RVU16B, RVU16C, RVU16D.
July 1, 2015
RVU15C
$169.85changed to$170.70
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$167.41changed to$169.85
- Conversion factor 35.8228 changed to 35.7547
- Practice expense RVU 3.36 changed to 3.42
- Malpractice RVU 0.08 changed to 0.09
- Malpractice GPCI 1.165 changed to 1.226
Held through RVU15B.
January 1, 2014
RVU14A
$170.40changed to$167.41
- Conversion factor 34.0230 changed to 35.8228
- Practice expense RVU 3.70 changed to 3.36
- Malpractice GPCI 1.103 changed to 1.165
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $170.40
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $162.99 | $89.17 | RVU26D |
| 2026-07-01 | $162.99 | $89.17 | RVU26C |
| 2026-04-01 | $162.99 | $89.17 | RVU26B |
| 2026-01-01 | $162.99 | $89.17 | RVU26A |
| 2025-10-01 | $159.72 | $91.15 | RVU25D |
| 2025-07-01 | $159.72 | $91.15 | RVU25C |
| 2025-04-01 | $159.72 | $91.15 | RVU25B |
| 2025-01-01 | $159.72 | $91.15 | RVU25A |
| 2024-10-01 | $166.36 | $93.13 | RVU24D |
| 2024-07-01 | $166.36 | $93.13 | RVU24C |
| 2024-04-01 | $166.36 | $93.13 | RVU24B |
| 2024-03-09 | $166.36 | $93.13 | RVU24AR |
| 2024-01-01 | $163.65 | $91.61 | RVU24A |
| 2023-10-01 | $167.67 | $92.78 | RVU23D |
| 2023-07-01 | $167.67 | $92.78 | RVU23C |
| 2023-04-01 | $167.67 | $92.78 | RVU23B |
| 2023-01-01 | $167.67 | $92.78 | RVU23A |
| 2022-10-01 | $171.22 | $93.01 | RVU22D |
| 2022-07-01 | $171.22 | $93.01 | RVU22C |
| 2022-04-01 | $171.22 | $93.01 | RVU22B |
| 2022-01-01 | $171.22 | $93.01 | RVU22A |
| 2021-10-01 | $174.04 | $93.78 | RVU21D |
| 2021-07-01 | $174.04 | $93.78 | RVU21C |
| 2021-04-01 | $174.04 | $93.78 | RVU21B |
| 2021-01-01 | $174.04 | $93.78 | RVU21A |
| 2020-10-01 | $174.22 | $96.26 | RVU20D |
| 2020-07-01 | $174.22 | $96.26 | RVU20C |
| 2020-04-01 | $174.22 | $96.26 | RVU20B |
| 2020-01-01 | $174.22 | $96.26 | RVU20A |
| 2019-10-01 | $175.03 | $98.27 | RVU19D |
| 2019-07-01 | $175.03 | $98.27 | RVU19C |
| 2019-04-01 | $175.03 | $98.27 | RVU19B |
| 2019-01-01 | $175.03 | $98.27 | RVU19A |
| 2018-10-01 | $173.76 | $98.52 | RVU18D |
| 2018-07-01 | $173.76 | $98.52 | RVU18C |
| 2018-04-01 | $173.76 | $98.52 | RVU18B |
| 2018-01-01 | $173.76 | $98.52 | RVU18AR1 |
| 2017-10-01 | $171.50 | $97.93 | RVU17D |
| 2017-07-01 | $171.50 | $97.93 | RVU17C |
| 2017-04-01 | $171.50 | $97.93 | RVU17B |
| 2017-01-01 | $171.50 | $97.93 | RVU17A |
| 2016-10-01 | $170.08 | $96.68 | RVU16D |
| 2016-07-01 | $170.08 | $96.68 | RVU16C |
| 2016-04-01 | $170.08 | $96.68 | RVU16B |
| 2016-01-01 | $170.08 | $96.68 | RVU16A |
| 2015-10-01 | $170.70 | $97.03 | RVU15D |
| 2015-07-01 | $170.70 | $97.03 | RVU15C |
| 2015-04-01 | $169.85 | $96.55 | RVU15B |
| 2015-01-01 | $169.85 | $96.55 | RVU15A |
| 2014-10-01 | $167.41 | $95.40 | RVU14D |
| 2014-07-01 | $167.41 | $95.40 | RVU14C |
| 2014-04-01 | $167.41 | $95.40 | RVU14B |
| 2014-01-01 | $167.41 | $95.40 | RVU14A |
| 2013-10-01 | $170.40 | $94.52 | RVU13D |
| 2013-07-01 | $170.40 | $94.52 | RVU13C |
| 2013-04-01 | $170.40 | $94.52 | RVU13B |
| 2013-01-01 | $170.40 | $94.52 | RVU13AR |
Where the Montana rate applies
Montana is a Medicare payment area, not a city. Our Census mapping connects it to 497 cities and communities in Montana. Some span more than one payment area; confirm with the service ZIP.
- Absarokee
- Acton
- Alberton
- Alder
- Alzada
- Amsterdam
- Anaconda-Deer Lodge County
- Antelope
11765 billing questions
How is this different from a nail avulsion?
This code describes excision of skin from the nail fold. A nail avulsion removes the nail plate; report that service only when the plate is separately removed.
When would 11750 be more appropriate?
Use 11750 when the procedure excises the nail and nail matrix, rather than removing a wedge of skin from the fold. The operative documentation should identify the tissue removed.
Can modifier 50 be used for procedures on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code, so modifier 50 should not be used.
Are postoperative visits separately payable during the global period?
Related postoperative visits during the 10-day global period are included in the procedure payment.
Can an assistant or co-surgeon be billed?
Medicare does not pay an assistant at surgery for this procedure. 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
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