Billing code 11765: Nail-fold excisionMedicare rate & RVUs in Washington
Report this procedure when a clinician surgically removes a wedge of skin from a nail fold, commonly to treat an ingrown nail.
Medicare pays $169.17–$191.73 for 11765 in the office in Washington, from Rest Of Washington to Seattle (King Cnty). 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 11765 covers
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.
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 11765 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | $169.17 | $91.44 |
| Seattle (King Cnty) | $191.73 | $101.16 |
How the 11765 rate is calculated
Each of 11765’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 · 11765
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.19Practice expense 3.60Malpractice 0.09
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 11765
11765 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 11765
Nail-fold excision
| 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 · 11765
Nail-fold excision
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
11765 without 51 · national office
$163.00
Nail-fold excision
11765-51 · Second procedure: 50%
$81.50
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%).
11765 compared with similar codes
Compare codes
11765 vs 11730 vs 11750 vs 11755: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 11730Nail avulsion
- 11730 removes a nail plate. Choose 11765 when the documented procedure excises skin from the nail fold instead.
- 11750Nail matrix excision
- 11750 involves excision of the nail and matrix. This code is for wedge excision of nail-fold skin, without that broader target.
- 11755Nail biopsy
- 11755 is for diagnostic sampling of the nail unit. Use 11765 for therapeutic removal of nail-fold skin, not a biopsy.
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 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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