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See a sample rate comparisonCPT 11765 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Wedge Excision Of Skin Of Nail, Wedge Excision Of Skin Of Nail Fold (Eg For Ingrowntoenail) Wedge Excision Of Skin Of Nail Fold (Eg For Ingrown
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Integumentary System |
| Common Place of Service | 11 - Office 20 - Urgent Care Facility |
| Common Modifiers | None TA - Left foot, great toe T5 - Right foot, great toe |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 11765 |
| Medicaid Fee Schedule | View Medicaid rates for 11765 |
National average reimbursement for CPT 11765 by major payers:
$183.08
$195.88
$202.86
$255.77
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CPT 11765
5 of 25 sample ratesHigher to lower in this preview
Iu Health East Washington Ambulatory Surgery Center, LLC, East Washington Surgery Center
$4,613.00Published rateAdventhealth Surgery Center Wellswood LLC, Adventhealth Surgery Center Wellswood
Adventhealth Surgery Center Wellswood LLC
$566.00Published ratePrisma Health Ambulatory Surgery Centers-Midlands, LLC, Prisma Health Orthopedic Surgery Center
Prisma Health Ambulatory Surgery Centersmidlands LLC
$188.00Published rateCarbon Schuylkill Endoscopy Center,Inc
Carbon Schuylkill Endoscopy Centerinc
$100.00Published rateJ J Young Md, The Cataract Center Of Lawton
J J Young Md
$56.00Published rate
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See a sample payer proposalCPT 11765 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 11765 code is part of the Surgery services used for Surgical Procedures on the Integumentary System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 11765 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 11765-CPT | Low | Wedge Excision Of Skin Of Nail, Wedge Excision Of Skin Of Nail Fold (Eg For Ingrowntoenail) Wedge Excision Of Skin Of Nail Fold (Eg For Ingrown |
| 11770-CPT | Moderate | Exc Pilonidal Cyst/Sinus Simple |
| 11771-CPT | Moderate | Exc Pilonidal Cyst/Sinus Extensive |
| 11772-CPT | Moderate | Exc Pilonidal Cyst/Sinus Complic |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 11765. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 11765 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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