CPT code 11772: Pilonidal excision, complicated disease2026 Medicare rate & RVUs in Missouri
Report this code for surgical excision of complicated pilonidal disease in the sacrococcygeal cleft, supported by operative documentation of the case’s complexity.
Medicare pays $769.85–$821.04 for 11772 in the office in Missouri, from Rest of Missouri to Metropolitan St. Louis, MO. 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 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.
Where 11772 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$769.85 to $821.04
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | $812.46 | $555.28 |
| Metropolitan St. Louis, MO | $821.04 | $560.30 |
| Rest of Missouri | $769.85 | $533.76 |
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
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.
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
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 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) | 0.10/0.71/0.19 | Share 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.
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%).
11772 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 11770Pilonidal excisionSimple excision
- 11770 describes excision of simple pilonidal disease. Use 11772 when the operative findings and work support a complicated case.
- 11771Pilonidal excisionExtensive disease
- 11771 describes extensive pilonidal disease, while 11772 describes complicated disease. The operative documentation should support the level selected.
- 10081Pilonidal drainageComplicated incision and drainage
- 10081 is for incision and drainage of a complicated pilonidal abscess. Use 11772 when the performed service is excision of the cyst or sinus.
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
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