Billing code 10081: Pilonidal drainageMedicare rate & RVUs in Illinois
Reports surgical opening and drainage of a complicated pilonidal cyst or abscess in the natal cleft when the documented treatment is more involved than simple drainage.
Medicare pays $364.54–$402.85 for 10081 in the office in Illinois, from Rest Of Illinois to Chicago. 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.
On this page 9 sections
What 10081 covers
This service treats an infected pilonidal cavity in the cleft between the buttocks, typically near the tailbone. A surgeon or other qualified practitioner opens the affected area to release pus and may explore or irrigate the cavity and manage its wound as clinically indicated. It is commonly performed in an office, emergency department, or outpatient surgical setting for a painful, swollen, draining pilonidal abscess.
Choose this code when the record supports complicated rather than simple pilonidal drainage; document the site, infection findings, extent of the cavity, work performed, and why the procedure was complex. The service has a 10-day global period, so related postoperative visits during that period are included. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this service, and co-surgeon and team-surgery reporting 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 10081 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
4 payment localities
$364.54 to $402.85
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | $402.85 | $190.36 |
| East St. Louis | $373.75 | $179.24 |
| Rest Of Illinois | $364.54 | $171.51 |
| Suburban Chicago | $400.68 | $183.54 |
How the 10081 rate is calculated
Each of 10081’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 · 10081
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 2.44Practice expense 8.46Malpractice 0.48
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 10081
10081 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 10081
Pilonidal drainage
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 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) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 10081
Pilonidal drainage
10-day global period ends
Oct 11, 2026
Covers Oct 1, 2026 through Oct 11, 2026 (11 days).
Visit on Oct 31, 2026
After the global period ends: visits and procedures are billed normally.
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
10081 without 51 · national office
$380.10
Pilonidal drainage
10081-51 · Second procedure: 50%
$190.05
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%).
10081 compared with similar codes
Compare codes
10081 vs 10080 vs 10060 vs 10061 vs 11770: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 10080Pilonidal drainage
- Both address pilonidal disease, but 10080 is for simple drainage; report 10081 when the documented drainage is complicated.
- 10060Abscess drainage
- 10060 covers simple or single abscess drainage generally. Use 10081 for complicated drainage of a pilonidal cyst in the natal cleft.
- 10061Abscess drainage
- 10061 is for complicated or multiple abscess drainage generally; 10081 is the pilonidal-specific code when that condition is being drained.
- 11770Pilonidal excision
- 11770 describes excision of pilonidal disease, whereas 10081 reports incision and drainage of a complicated pilonidal cyst or abscess.
10081 billing questions
How do I choose between 10080 and 10081?
Use 10080 for simple pilonidal cyst drainage and 10081 when the operative note supports a complicated procedure. Document the extent and specific work that make the drainage more involved.
How is 10081 different from general abscess drainage?
10081 is specific to complicated drainage of a pilonidal cyst in the natal cleft. Codes 10060 and 10061 describe drainage of other abscesses rather than this pilonidal-specific service.
Are related postoperative visits separately reported?
Related postoperative visits during the 10-day global period are included in the procedure payment.
Can modifier 50 be used for bilateral disease?
No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this service.
Can an assistant or co-surgeon be billed?
Medicare does not pay an assistant at surgery for 10081. Co-surgeons and team surgery are not permitted.
What happens if another procedure is performed in the same session?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are subject to the reduction.
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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