How much does Medicare pay for CPT 11765?

Medicare allowed an average of $143.69 per service and paid $109.91 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $278.62, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 11765?

Removal of skin of fingernail or toenail. It was billed 40,363 times to 22,498 Medicare beneficiaries by 375 providers in 2024.

Does 11765 pay differently in an office than a hospital?

Yes. The allowed amount averaged $148.95 in an office setting and $89.45 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 11765 most?

Podiatry, with 37,984 services from 354 clinicians. Next are Nurse Practitioner, General Practice, Physician Assistant.

CPT 11765

Removal of skin of fingernail or toenail

$143.69Medicare-allowed amount per service, averaged across 40,363 services

Providers submitted

$278.62

Asking price, not received

Medicare allowed

$143.69

The fee schedule figure

Medicare paid

$109.91

Balance is patient coinsurance

Providers submitted an average of $278.62 for this code and Medicare allowed $143.69 — 1.9× 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 $109.91 (76%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $148.95
Hospital / facility: $89.45

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. 36,794 services were billed in an office setting and 3,569 in a facility.

Services: 40,363
Beneficiaries: 22,498
Providers billing it: 375
Total allowed: $5,799,759

What Medicare pays for CPT 11765

Across 40,363 services billed by 375 providers to 22,498 beneficiaries, Medicare allowed an average of $143.69 per service. That is 1.8 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 11765

Specialty	Services	Beneficiaries	Avg allowed	Providers
Podiatry	37,984	21,371	$145.68	354
Nurse Practitioner	989	510	$112.96	12
General Practice	888	310	$101.47	2
Physician Assistant	240	176	$138.94	3
Family Practice	206	86	$105.94	1
Internal Medicine	56	45	$163.16	3

11765 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	13,790	$142.45	$100.09	91
Texas	6,227	$137.26	$108.33	42
Florida	4,590	$143.94	$111.42	29
New York	4,487	$169.59	$116.53	43
Arizona	2,116	$137.24	$104.42	35
Indiana	1,004	$138.92	$117.47	14
Tennessee	824	$107.05	$88.93	9
New Jersey	769	$160.94	$111.39	10
Ohio	675	$128.68	$95.35	6
Georgia	600	$122.05	$102.74	8
Pennsylvania	585	$160.40	$116.58	9
Maryland	523	$162.73	$121.82	7
Michigan	522	$131.50	$109.91	5
Alabama	517	$108.81	$93.09	3
Rhode Island	495	$160.00	$122.35	3
South Carolina	475	$142.76	$111.79	6
Illinois	409	$151.97	$114.99	10
Virginia	362	$149.68	$114.42	10
New Mexico	185	$120.57	$100.40	3
Arkansas	139	$137.51	$112.64	4
Nevada	136	$147.94	$111.55	2
Connecticut	127	$163.37	$127.00	1
Washington	120	$173.45	$119.62	4
New Hampshire	91	$158.01	$114.51	1
Oregon	76	$149.41	$100.63	2
Idaho	74	$148.96	$116.07	2
Wisconsin	70	$133.25	$104.66	3
North Dakota	57	$83.15	$62.27	1
Alaska	50	$85.99	$51.01	1
Kentucky	49	$114.99	$103.89	2
Iowa	46	$79.18	$66.55	1
Louisiana	44	$136.21	$111.96	1
North Carolina	34	$144.74	$112.34	2
Oklahoma	29	$134.44	$111.52	1
Maine	21	$87.76	$51.96	1
Minnesota	18	$84.26	$60.85	1
Colorado	14	$157.67	$117.01	1
Utah	13	$144.17	$128.27	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
11755Biopsy of fingernail or toenail$106.95
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.