CPT 11770Surgery

Remove pilonidal cyst simple

CPT 11770 covers the surgical removal of a simple pilonidal cyst, a painful skin infection that develops near the tailbone. This is a straightforward excision procedure typically performed in an outpatient setting.

Showing rates for

National Average

Base Medicare rate

$337.37

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

2.66

PE RVU (NF)

7.17

MP RVU

0.6

Total RVU

10.43

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Distinguish simple (11770) from intermediate (11771) and complex (11772) based on extent of dissection and closure method
Impact: Proper code selection prevents $100-300 undercoding or upcoding denials; 11771 pays approximately $550 vs $337.37 for 11770
Bill in non-facility setting when performed in office to capture higher rate ($337.37 vs $181.14 facility rate)
Impact: $156.23 higher reimbursement (86% increase) for office-based procedures
Document exact size of excision, depth to presacral fascia, and absence of complex features to support 11770 classification
Impact: Reduces audit risk and supports medical necessity; prevents downcoding from inadequate documentation
Do not bundle separately billable E/M services on same day without modifier 25 when significant separately identifiable evaluation occurs
Impact: Captures additional $75-200 for appropriate pre-procedure decision-making visits
Verify global period (90 days for 11770) before billing follow-up visits; only complications or unrelated services are separately billable
Impact: Prevents denials for routine postoperative care included in surgical package
For recurrent pilonidal disease, append modifier 76 and include prior surgery dates in documentation to justify medical necessity
Impact: Supports claim approval and prevents denials for repeat procedures within expected timeframe

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 11770 in 2025?

The 2025 Medicare national average payment for CPT 11770 is $337.37 in non-facility settings (such as physician offices) and $181.14 in facility settings (such as hospital outpatient departments or ASCs). The facility rate is lower because the facility bills separately for overhead costs.

What is the difference between CPT 11770, 11771, and 11772?

CPT 11770 is for simple pilonidal cyst removal with limited excision and straightforward closure. CPT 11771 covers extensive excision with primary closure requiring more dissection. CPT 11772 involves complicated procedures requiring flap reconstruction or marsupializaton. The complexity of sinus tracts, extent of undermining, and closure method determine the appropriate code.

How many RVUs is CPT code 11770 worth?

CPT 11770 has a total of 10.43 RVUs for 2025, consisting of 2.66 work RVUs, 7.17 non-facility practice expense RVUs (2.34 facility PE RVUs), and 0.60 malpractice RVUs. These values are multiplied by the 2025 conversion factor of 32.3465 to determine payment.

Can I bill an E/M visit with CPT 11770 on the same day?

Yes, but only if a significant, separately identifiable evaluation and management service is performed and documented beyond the typical pre-procedure assessment. You must append modifier 25 to the E/M code and clearly document the separate nature of the service, such as addressing other medical conditions or making the initial decision for surgery.

What diagnosis codes support medical necessity for CPT 11770?

Primary ICD-10 codes include L05.91 (pilonidal cyst with abscess) and L05.92 (pilonidal cyst without abscess). L05.01 and L05.02 cover pilonidal sinus conditions. Documentation should show symptomatic disease with pain, infection, drainage, or functional impairment to support medical necessity.

Does CPT 11770 have a global period?

Yes, CPT 11770 has a 90-day global surgical period. This means routine postoperative care for 90 days after surgery is included in the reimbursement and cannot be billed separately. Only treatment of complications, exacerbations, or unrelated conditions can be billed during the global period.

What is the typical reimbursement for CPT 11770 from commercial insurance?

Commercial insurance reimbursement varies widely but typically ranges from 120-250% of Medicare rates. For CPT 11770, this translates to approximately $400-$850 in non-facility settings, depending on the payer contract, geographic location, and network status. Always verify specific payer fee schedules for accurate estimates.