How much does Medicare pay for CPT 11755?

Medicare allowed an average of $106.95 per service and paid $80.51 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $233.79, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 11755?

Biopsy of fingernail or toenail. It was billed 49,228 times to 39,207 Medicare beneficiaries by 806 providers in 2024.

Does 11755 pay differently in an office than a hospital?

Yes. The allowed amount averaged $107.64 in an office setting and $48.05 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 11755 most?

Podiatry, with 43,556 services from 767 clinicians. Next are Nurse Practitioner, Physician Assistant, Dermatology.

CPT 11755

Biopsy of fingernail or toenail

$106.95Medicare-allowed amount per service, averaged across 49,228 services

Providers submitted

$233.79

Asking price, not received

Medicare allowed

$106.95

The fee schedule figure

Medicare paid

$80.51

Balance is patient coinsurance

Providers submitted an average of $233.79 for this code and Medicare allowed $106.95 — 2.2× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $80.51 (75%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $107.64
Hospital / facility: $48.05

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 48,660 services were billed in an office setting and 568 in a facility.

Services: 49,228
Beneficiaries: 39,207
Providers billing it: 806
Total allowed: $5,264,935

What Medicare pays for CPT 11755

Across 49,228 services billed by 806 providers to 39,207 beneficiaries, Medicare allowed an average of $106.95 per service. That is 1.3 services per beneficiary, so this is a code patients typically receive more than once. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 11755

Specialty	Services	Beneficiaries	Avg allowed	Providers
Podiatry	43,556	34,147	$106.71	767
Nurse Practitioner	4,186	3,656	$107.50	10
Physician Assistant	1,022	996	$110.48	6
Dermatology	407	367	$119.81	20
General Surgery	32	16	$105.51	1
Internal Medicine	14	14	$67.75	1
Pathology	11	11	$111.11	1

11755 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
California	17,501	$106.14	$75.83	91
Florida	4,691	$111.02	$82.97	94
Texas	3,624	$104.61	$81.28	71
New York	2,892	$120.69	$80.69	101
Illinois	2,456	$110.73	$83.65	60
New Jersey	2,025	$129.49	$86.33	50
Virginia	1,861	$104.00	$79.17	28
Arizona	1,855	$99.57	$78.44	41
Oregon	1,616	$85.58	$58.60	2
Georgia	1,312	$99.36	$79.17	35
Tennessee	1,256	$109.73	$87.91	27
Indiana	931	$100.70	$78.12	13
New Mexico	706	$92.34	$71.13	13
South Carolina	696	$106.60	$83.73	19
Utah	613	$92.21	$70.87	11
Ohio	550	$105.93	$79.57	20
Colorado	472	$114.28	$81.52	6
Massachusetts	437	$104.53	$69.62	10
Alabama	380	$90.06	$68.52	5
Nevada	367	$96.66	$76.78	8
Maryland	340	$104.25	$72.82	8
Michigan	330	$112.52	$86.73	15
Pennsylvania	290	$120.82	$85.51	15
Kansas	269	$106.48	$87.12	2
Puerto Rico	223	$100.05	$75.22	4
Louisiana	218	$106.68	$84.11	8
Arkansas	216	$100.22	$86.22	7
Kentucky	178	$103.80	$79.94	6
Nebraska	166	$86.70	$70.27	5
Connecticut	154	$126.62	$89.45	6
Missouri	98	$110.69	$81.73	5
North Carolina	83	$102.78	$79.53	4
Washington	73	$104.00	$76.70	3
New Hampshire	67	$117.12	$83.08	2
Alaska	56	$113.17	$71.64	1
Delaware	43	$118.43	$91.33	1
West Virginia	39	$102.35	$81.61	1
Wisconsin	38	$112.10	$81.64	1
Oklahoma	26	$117.60	$89.39	2
Rhode Island	21	$123.30	$81.87	1
Maine	19	$117.10	$80.42	1
Iowa	17	$107.75	$84.05	1
Idaho	12	$100.78	$71.75	1
Montana	11	$113.44	$78.37	1

Related codes

11721Removal of fingernails or toenails$42.83
11720Removal of fingernails or toenails$31.70
11719Trimming of fingernails or toenails$10.40
11730Simple separation of fingernail or toenail from nail bed$108.98
11750Permanent removal fingernail or toenail$140.90
11765Removal of skin of fingernail or toenail$143.69
11732Simple separation of fingernail or toenail from nail bed$32.18
11740Removal of blood accumulation under fingernail or toenail$40.74
11760Repair of fingernail or toenail bed$122.75

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.