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See a sample rate comparisonCPT 11772 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.
Exc Pilonidal Cyst/Sinus Complic
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Integumentary System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 24 - Ambulatory Surgical Center |
| Common Modifiers | None SG - Scene to Hospital ESRD facility 51 - Multiple procedures |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 11772 |
| Medicaid Fee Schedule | View Medicaid rates for 11772 |
National average reimbursement for CPT 11772 by major payers:
$833.53
$892.21
$968.64
$929.81
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CPT 11772
5 of 25 sample ratesHigher to lower in this preview
Memorial Hermann Endoscopy Center North Freeway LLC, Memorial Hermann Endoscopy Center North Loop
$5,729.00Published rateInterventional Pain Management LLC
$1,457.00Published rateKramberg Obs
$1,213.00Published rateFlorence Surgery Center, L.P., Florence Surgery Center
Florence Surgery Center Lp
$743.00Published rateTranssouth Health Care PLLC, Transsouth Health Care PC
Transsouth Health Care, P.C.
$520.00Published rate
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See a sample payer proposalCPT 11772 vs. Other Surgical Procedures on the Integumentary System Codes
The CPT 11772 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 11772 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 11772. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 11772 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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