$345.88
11770 describes excision of simple pilonidal disease. Use 11772 when the operative findings and work support a complicated case.
On this page
CMS RVU26D · Effective 2026-10-01
11772 Pilonidal excision Medicare reimbursement rates in Alabama
Report this code for surgical excision of complicated pilonidal disease in the sacrococcygeal cleft, supported by operative documentation of the case’s complexity. Compare 11772 office and facility rates across CMS payment localities in Alabama.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 11772 in Alabama?
Alabama has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$753.85
1 of 1 localities have a supported rate.
Payment area: Alabama
One mapped payment locality.
Facility setting
$514.20
1 of 1 localities have a supported rate.
Payment area: Alabama
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
General surgery
About 11772: Complicated pilonidal cyst excision
Report this code for surgical excision of complicated pilonidal disease in the sacrococcygeal cleft, supported by operative documentation of the case’s complexity.
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.
CMS billing rules for 11772
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU7.17 · 28%
- Practice expense (office) RVU16.50 · 65%
- Malpractice RVU1.70 · 7%
408
Medicare services in 2024 · #3722 by national volume
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.
11772 compared with similar codes
Office rates for Alabama, from the same CMS release.
$615.89
11771 describes extensive pilonidal disease, while 11772 describes complicated disease. The operative documentation should support the level selected.
$337.82
10081 is for incision and drainage of a complicated pilonidal abscess. Use 11772 when the performed service is excision of the cyst or sinus.
Compare 11772 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Alabama →
Office / nonfacility
$753.85
Facility
$514.20
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 11772 in Alabama.
PPRRVU2026_Oct_nonQPP.csv
1,374
- Code
- 11772
- Physician work
- 7.17
- Practice expense
- 16.50
- Malpractice
- 1.70
GPCI2026.csv
4
- Locality
- Alabama
- Physician work
- 1.000
- Practice expense
- 0.875
- Malpractice
- 0.566
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 7.17 | × 1.000 | 7.1700 |
| Practice expense | 16.50 | × 0.875 | 14.4375 |
| Malpractice | 1.70 | × 0.566 | 0.9622 |
| Total RVUs | 22.5697 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Alabama$753.85
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 7.17 | 1 |
| Practice expense | 16.5 | 0.875 |
| Malpractice | 1.7 | 0.566 |
(7.17 × 1 + 16.5 × 0.875 + 1.7 × 0.566) × $33.4009 = $753.85
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 7.17 | 1 |
| Practice expense | 8.3 | 0.875 |
| Malpractice | 1.7 | 0.566 |
(7.17 × 1 + 8.3 × 0.875 + 1.7 × 0.566) × $33.4009 = $514.20
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
1,37111765,,Wedge excision skn nail fold,A,,1.19,3.60,,1.39,,0.09,4.88,2.67,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,37211770,,Exc pilonidal cyst simple,A,,2.59,8.48,,2.22,,0.61,11.68,5.42,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,37311771,,Exc pilonidal cyst xtnsv,A,,5.94,13.36,,5.86,,1.43,20.73,13.23,0,090,0.10,0.71,0.19,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,37411772,,Exc pilonidal cyst comp,A,,7.17,16.50,,8.30,,1.70,25.37,17.17,0,090,0.10,0.71,0.19,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,3751180F,,Thromboemb risk assessed,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
1,3761181F,,Neuropsychia sympts assessed,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
1,3771182F,,Neuropsychi sympt 1+present,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
1ADDENDUM E. FINAL CY 2026 GEOGRAPHIC PRACTICE COST INDICES (GPCIs) BY STATE AND MEDICARE LOCALITY,,,,,,
2,,,,,,
3Medicare Administrative Contractor (MAC),State,Locality Number,Locality Name,2026 PW GPCI (with 1.0 Floor)***,2026 PE GPCI,2026 MP GPCI
410112,AL,00,ALABAMA,1.000,0.875,0.566
502102,AK,01,ALASKA*,1.500,1.065,0.551
603102,AZ,00,ARIZONA,1.000,0.969,0.856
707102,AR,13,ARKANSAS,1.000,0.859,0.515