Billing code 10080: Pilonidal drainageMedicare rate & RVUs

Medicare pays $269.55 for 10080 nationally in the office and $105.21 in a hospital or facility. Local office rates run $234.85–$369.44.

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

What 10080 covers

This service is a limited incision and drainage of a pilonidal cyst or abscess in the cleft between the buttocks. A physician or other qualified practitioner typically performs it in an office, emergency department, or outpatient setting, often using local anesthesia. The aim is to release the collection rather than excise the pilonidal tract or cyst.

Select this code for a simple drainage; use the complex pilonidal code when the procedure is more involved. The note should identify the pilonidal site and describe the incision and drainage performed. Medicare assigns a 10-day global period, so related postoperative visits during that period are included. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are subject to a 50% reduction. Modifier 50 is inappropriate for this code. Medicare does not pay for an assistant at surgery, and co-surgeon and team-surgery billing 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 10080 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

10080 rates by state

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

How the 10080 rate is calculated

Each of 10080’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.

Payment rules and modifiers for 10080

10080 has a 10-day global period: related visits in that window are included in the surgery payment.

What modifiers do to the payment

When to use modifier 51

10080 compared with similar codes

How to choose

10081Pilonidal drainage

Both address pilonidal disease, but 10081 is for complex drainage; this code is for simple drainage.

10060Abscess drainage

10060 is for simple drainage of a single abscess not coded as pilonidal. Use this code when the drained lesion is pilonidal.

10061Abscess drainage

10061 covers complex or multiple abscess drainage outside the pilonidal-specific code pathway. For complex pilonidal drainage, compare 10081.

11770Pilonidal excision

11770 describes excision of a pilonidal cyst or sinus, while this code describes incision and drainage without excision.

Codes related to 10080

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

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

Open CMS sourceHow we calculate rates