$118.56
11730 removes a nail plate. Choose 11765 when the documented procedure excises skin from the nail fold instead.
On this page
CMS RVU26D · Effective 2026-10-01
11765 Nail-fold excision Medicare reimbursement rates in Connecticut
Report this procedure when a clinician surgically removes a wedge of skin from a nail fold, commonly to treat an ingrown nail. Compare 11765 office and facility rates across CMS payment localities in Connecticut.
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 11765 in Connecticut?
Connecticut 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
$173.68
1 of 1 localities have a supported rate.
Payment area: Connecticut
One mapped payment locality.
Facility setting
$94.18
1 of 1 localities have a supported rate.
Payment area: Connecticut
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.
Nail surgery
About 11765: Nail-fold wedge excision
Report this procedure when a clinician surgically removes a wedge of skin from a nail fold, commonly to treat an ingrown nail.
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.
CMS billing rules for 11765
- Global period
- Minor procedure with a 10-day global period: related postoperative visits for 10 days 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 RVU1.19 · 24%
- Practice expense (office) RVU3.60 · 74%
- Malpractice RVU0.09 · 2%
45.2K
Medicare services in 2024 · #819 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.
11765 compared with similar codes
Office rates for Connecticut, from the same CMS release.
$167.48
11750 involves excision of the nail and matrix. This code is for wedge excision of nail-fold skin, without that broader target.
$126.95
11755 is for diagnostic sampling of the nail unit. Use 11765 for therapeutic removal of nail-fold skin, not a biopsy.
Compare 11765 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
Connecticut →
Office / nonfacility
$173.68
Facility
$94.18
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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 11765 in Connecticut.
PPRRVU2026_Oct_nonQPP.csv
1,371
- Code
- 11765
- Physician work
- 1.19
- Practice expense
- 3.60
- Malpractice
- 0.09
GPCI2026.csv
38
- Locality
- Connecticut
- Physician work
- 1.020
- Practice expense
- 1.077
- Malpractice
- 1.210
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.19 | × 1.020 | 1.2138 |
| Practice expense | 3.60 | × 1.077 | 3.8772 |
| Malpractice | 0.09 | × 1.210 | 0.1089 |
| Total RVUs | 5.1999 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Connecticut$173.68
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.19 | 1.02 |
| Practice expense | 3.6 | 1.077 |
| Malpractice | 0.09 | 1.21 |
(1.19 × 1.02 + 3.6 × 1.077 + 0.09 × 1.21) × $33.4009 = $173.68
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.19 | 1.02 |
| Practice expense | 1.39 | 1.077 |
| Malpractice | 0.09 | 1.21 |
(1.19 × 1.02 + 1.39 × 1.077 + 0.09 × 1.21) × $33.4009 = $94.18
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.
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 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.
1,3681175F,,Function stat assessed rvwd,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
1,36911760,,Repair of nail bed,A,,1.59,3.81,,1.33,,0.19,5.59,3.11,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,37011762,,Reconstruction of nail bed,A,,2.87,5.60,,2.03,,0.34,8.81,5.24,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1,37111765,,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
3501112,CA,70,YUBA CITY,1.017,1.096,0.536
3601112,CA,75,REST OF CALIFORNIA,1.017,1.096,0.536
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899
4109102,FL,03,FORT LAUDERDALE,1.000,1.013,1.808