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CPT code 11772: Pilonidal excision, complicated disease2026 Medicare rate & RVUs in Delaware

Report this code for surgical excision of complicated pilonidal disease in the sacrococcygeal cleft, supported by operative documentation of the case’s complexity.

CMS RVU26DEffective Oct 1, 2026One payment locality408 Medicare services in 2024

In Delaware, Medicare pays $836.23 for 11772 in the office and $565.63 when it’s performed in a hospital or facility.

$836.23Office (non-facility)
$565.63Hospital or facility
−1.3%vs the national office rate ($847.38)

Check a contract rate as a % of Medicare · 11772 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 11772 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Delaware
  2. What 11772 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 11772 covers

A surgeon excises complicated pilonidal disease involving a cyst or sinus in the natal cleft near the coccyx. The procedure is generally performed in an operating room, often for disease with a complex course or extent that requires more involved excision than a simple case. The wound may be managed according to the operative plan; closure method alone does not establish the code level.

Select this code when the operative report supports complicated disease and the work performed, rather than choosing by diagnosis wording alone. Document the involved area, sinus or cyst extent, and the operative findings and technique that support the complexity. This major surgery has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same 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 Delaware compares for 11772

Across 109 of 109 payment localities, the office rate for 11772 runs from $742.13 in Arkansas to $1,090.97 in San Benito County, CA. Delaware pays $836.23. The RVUs are the same everywhere; the geographic indexes change the dollars.

11772 in Delaware vs other payment areas
  1. Delaware · this page$836.23
  2. Los Angeles, CA · California$938.98+$102.75
  3. Washington, DC area · District of Columbia$964.83+$128.60
  4. Miami, FL · Florida$956.80+$120.57
  5. Chicago, IL · Illinois$925.34+$89.11
  6. Manhattan, NY · New York$985.26+$149.03
  7. Alaska · Alaska$977.45+$141.22

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

Every other payment area

11772 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$753.85$514.20
ArkansasArkansas$742.13$506.87
ArizonaArizona$822.12$556.72
Bakersfield, CACalifornia$882.64$582.46
Chico, CACalifornia$878.01$577.83
El Centro, CACalifornia$878.30$578.12
Fresno, CACalifornia$878.01$577.83
Hanford, CACalifornia$878.01$577.83

11772 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.

$742.13

$984.49

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

View every state and territory as a table
11772 office rate range by state
State / territoryOffice rate rangeLocalities
AK$977.451
AL$753.851
AR$742.131
AZ$822.121
CA$878.01–$1,090.9729
CO$873.091
CT$906.531
DC$964.831
DE$836.231
FL$851.69–$956.803
GA$798.76–$868.332
GU$898.981
HI$898.981
IA$766.301
ID$773.371
IL$831.40–$925.344
IN$777.961
KS$766.311
KY$781.381
LA$781.62–$822.592
MA$868.90–$957.872
MD$851.73–$964.833
ME$781.83–$821.472
MI$806.76–$867.042
MN$823.391
MO$769.85–$821.043
MS$755.961
MT$847.271
NC$789.961
ND$813.651
NE$769.631
NH$862.881
NJ$913.17–$954.512
NM$813.051
NV$838.451
NY$802.96–$1,015.535
OH$799.891
OK$775.751
OR$828.31–$897.852
PA$799.07–$885.252
PR$852.591
RI$863.991
SC$796.981
SD$809.681
TN$770.941
TX$793.75–$873.358
UT$808.521
VA$821.32–$964.832
VI$852.591
VT$813.821
WA$866.13–$974.072
WI$784.941
WV$799.661
WY$832.621

See 11772 in every payment locality

How the 11772 rate is calculated

Each of 11772’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 · 11772

RVUs × geographic indexes × conversion factor

Office or facility?

Work7.17

7.17 RVUs× 1.000 GPCI

Practice expense16.50

16.50 RVUs× 1.000 GPCI

Malpractice1.70

1.70 RVUs× 1.000 GPCI

Adjusted RVUs

25.3700

Conversion factor

$33.4009

Medicare rate

$847.38

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

1,374

Code
11772
Physician work
7.17
Practice expense
16.50
Malpractice
1.70

GPCI2026.csv

40

Locality
Delaware
Physician work
1.005
Practice expense
0.988
Malpractice
0.899
Office calculation for 11772 in Delaware
ComponentRVULocality factorAdjusted
Physician work7.17× 1.0057.2058
Practice expense16.50× 0.98816.3020
Malpractice1.70× 0.8991.5283
Total RVUs25.0361
Conversion factor× 33.4009

Office rate, Delaware$836.23

Office: (7.17 × 1.005 + 16.5 × 0.988 + 1.7 × 0.899) × $33.4009 = $836.23

Facility: (7.17 × 1.005 + 8.3 × 0.988 + 1.7 × 0.899) × $33.4009 = $565.63

Open 11772 in the RVU calculator

Payment rules and modifiers for 11772

11772 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 11772

Pilonidal excision, complicated disease

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are 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)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.71/0.19Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 11772

Pilonidal excision, complicated disease

90-day global period ends

Dec 30, 2026

Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).

Visit on Oct 31, 2026

Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

11772 without 51 · national office

$847.38

Pilonidal excision, complicated disease

11772-51 · Second procedure: 50%

$423.69

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 11772

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

Codes related to 11772
CodeHow it relatesOffice range, Delaware
Same family
11770Pilonidal excision, simple excisionSibling code for excision of simple pilonidal disease.$385.10
11771Pilonidal excision, extensive diseaseSibling code for excision of extensive pilonidal disease.$683.21
Used instead
10080Pilonidal drainage, simple incision and drainageSimple pilonidal abscess drainage when the service is incision and drainage, not excision.$266.39
10081Pilonidal drainage, complicated incision and drainageComplicated pilonidal abscess drainage when the service is incision and drainage, not excision.$375.50

How 11772 has changed in Delaware

11772 · Office / nonfacility

$836.23

Effective 2026-10-01

The base rate is $91.08 higher than on 2025-10-01, moving from $745.15 to $836.23 (12.2%).

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

    $745.15changed to$836.23

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 7.35 changed to 7.17
    • Practice expense RVU 14.12 changed to 16.50
    • 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

    $770.19changed to$745.15

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 14.26 changed to 14.12
    • Malpractice RVU 1.66 changed to 1.70

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $757.62changed to$770.19

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $790.31changed to$757.62

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 14.31 changed to 14.26
    • Malpractice RVU 1.61 changed to 1.66
    • 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

    $817.85changed to$790.31

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 14.40 changed to 14.31
    • Malpractice RVU 1.65 changed to 1.61
    • 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

    $807.97changed to$817.85

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 13.96 changed to 14.40
    • Malpractice RVU 1.62 changed to 1.65

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $768.09changed to$807.97

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 11.99 changed to 13.96
    • Malpractice RVU 1.61 changed to 1.62
    • 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

    $740.81changed to$768.09

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 11.13 changed to 11.99
    • Malpractice RVU 1.62 changed to 1.61
    • 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

    $731.19changed to$740.81

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 10.89 changed to 11.13

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $727.01changed to$731.19

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 10.77 changed to 10.89
    • Malpractice RVU 1.63 changed to 1.62
    • 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

    $728.22changed to$727.01

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 10.79 changed to 10.77
    • Malpractice RVU 1.64 changed to 1.63
    • 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

    $731.88changed to$728.22

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 10.86 changed to 10.79
    • Malpractice RVU 1.60 changed to 1.64

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $728.24changed to$731.88

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $709.79changed to$728.24

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 10.73 changed to 10.86
    • Malpractice RVU 1.41 changed to 1.60
    • 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

    $713.98changed to$709.79

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 12.03 changed to 10.73
    • Malpractice RVU 1.47 changed to 1.41
    • 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: $713.98

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$836.23$565.63RVU26D
2026-07-01$836.23$565.63RVU26C
2026-04-01$836.23$565.63RVU26B
2026-01-01$836.23$565.63RVU26A
2025-10-01$745.15$566.42RVU25D
2025-07-01$745.15$566.42RVU25C
2025-04-01$745.15$566.42RVU25B
2025-01-01$745.15$566.42RVU25A
2024-10-01$770.19$579.98RVU24D
2024-07-01$770.19$579.98RVU24C
2024-04-01$770.19$579.98RVU24B
2024-03-09$770.19$579.98RVU24AR
2024-01-01$757.62$570.52RVU24A
2023-10-01$790.31$589.32RVU23D
2023-07-01$790.31$589.32RVU23C
2023-04-01$790.31$589.32RVU23B
2023-01-01$790.31$589.32RVU23A
2022-10-01$817.85$603.52RVU22D
2022-07-01$817.85$603.52RVU22C
2022-04-01$817.85$603.52RVU22B
2022-01-01$817.85$603.52RVU22A
2021-10-01$807.97$606.84RVU21D
2021-07-01$807.97$606.84RVU21C
2021-04-01$807.97$606.84RVU21B
2021-01-01$807.97$606.84RVU21A
2020-10-01$768.09$610.75RVU20D
2020-07-01$768.09$610.75RVU20C
2020-04-01$768.09$610.75RVU20B
2020-01-01$768.09$610.75RVU20A
2019-10-01$740.81$612.28RVU19D
2019-07-01$740.81$612.28RVU19C
2019-04-01$740.81$612.28RVU19B
2019-01-01$740.81$612.28RVU19A
2018-10-01$731.19$609.77RVU18D
2018-07-01$731.19$609.77RVU18C
2018-04-01$731.19$609.77RVU18B
2018-01-01$731.19$609.77RVU18AR1
2017-10-01$727.01$607.82RVU17D
2017-07-01$727.01$607.82RVU17C
2017-04-01$727.01$607.82RVU17B
2017-01-01$727.01$607.82RVU17A
2016-10-01$728.22$608.61RVU16D
2016-07-01$728.22$608.61RVU16C
2016-04-01$728.22$608.61RVU16B
2016-01-01$728.22$608.61RVU16A
2015-10-01$731.88$610.37RVU15D
2015-07-01$731.88$610.37RVU15C
2015-04-01$728.24$607.33RVU15B
2015-01-01$728.24$607.33RVU15A
2014-10-01$709.79$590.06RVU14D
2014-07-01$709.79$590.06RVU14C
2014-04-01$709.79$590.06RVU14B
2014-01-01$709.79$590.06RVU14A
2013-10-01$713.98$584.69RVU13D
2013-07-01$713.98$584.69RVU13C
2013-04-01$713.98$584.69RVU13B
2013-01-01$713.98$584.69RVU13AR

Price 11772 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

11772 billing questions

How does this code differ from 11771?

Both describe excision of pilonidal disease, but this code is for a complicated case, while 11771 is for an extensive case. The operative report should support the selected level through the disease findings and work performed.

Can an abscess drainage code be used instead?

Use an incision-and-drainage code when the service is drainage rather than excision of the pilonidal cyst or sinus. The choice depends on the procedure actually performed, not simply the presence of an abscess.

What documentation supports the complicated level?

Document the cyst or sinus findings, extent and course of disease, and the operative work that makes the case complicated. A diagnosis of pilonidal disease by itself does not establish this level.

Are related postoperative visits separately reported?

Related postoperative care during the 90-day global period is included. The global period also includes the preoperative visit on the day before surgery.

Can modifier 50 or an assistant-at-surgery modifier be used?

Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery for this service.

What happens when another procedure is performed in the same session?

The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple procedure reduction. Co-surgeons and team surgery are not permitted for this code.

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 11772PPRRVU2026_Oct_nonQPP.csv, line 1,374 (RVU26D)
Geographic factors for DelawareGPCI2026.csv, line 40 (RVU26D)

Open CMS sourceHow we calculate rates

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