{"id":163577,"date":"2026-07-24T11:18:11","date_gmt":"2026-07-24T11:18:11","guid":{"rendered":"https:\/\/pabau.com\/?p=163577"},"modified":"2026-08-13T12:08:02","modified_gmt":"2026-08-13T12:08:02","slug":"cpt-code-10080","status":"publish","type":"post","link":"https:\/\/pabau.com\/de\/procedure-codes\/cpt-code-10080\/","title":{"rendered":"CPT Code 10080: Pilonidal cyst I&#038;D billing guide"},"content":{"rendered":"\n<script type=\"application\/ld+json\">{\"@context\":\"https:\/\/schema.org\",\"@type\":\"MedicalWebPage\",\"headline\":\"CPT Code 10080: Pilonidal cyst incision and drainage billing guide\",\"description\":\"CPT Code 10080 (incision and drainage of pilonidal cyst, simple) billing guide covering reimbursement rates, ICD-10 pairings (L05.01, L05.91), modifiers, documentation requirements, and common denial reasons.\",\"url\":\"https:\/\/pabau.com\/procedure-codes\/cpt-code-10080\/\",\"audience\":{\"@type\":\"MedicalAudience\",\"audienceType\":\"Clinician\"},\"reviewedBy\":{\"@type\":\"Person\",\"name\":\"Dr Vanja Kitanova\",\"jobTitle\":\"Medical Reviewer\",\"affiliation\":{\"@type\":\"Organization\",\"name\":\"Pabau\"},\"knowsAbout\":[\"Medical Coding\",\"Clinical Documentation\",\"Healthcare Billing\",\"Clinical Safety\"],\"sameAs\":\"https:\/\/pabau.com\/blog\/author\/vanja\/\"},\"datePublished\":\"2026-07-24\",\"dateModified\":\"2026-07-24\"}<\/script>\n\n\n        <div id=\"key_takeaways\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/12\/Key-Takeaways-Icon.svg\" alt=\"Key Takeaways\" height=\"42\" width=\"42\">\n                                <h3>Key Takeaways<\/h3>\n            <\/div>\n            <div class=\"list\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>CPT Code 10080 describes incision and drainage of a pilonidal cyst, simple &#8211; maintained by the AMA and used exclusively for straightforward, single-cavity drainage procedures<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>L05.01 (pilonidal cyst with abscess) is the primary ICD-10-CM pairing; L05.91 (without abscess) applies post-resolution or for cyst-without-infection drainage &#8211; selecting the wrong code is a leading denial trigger<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Medicare reimbursement differs by place of service: non-facility (office) rates are higher than facility rates because practice expense RVUs shift to the facility under POS 21\/22<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Modifier 25 is the most frequently needed modifier on 10080 claims, but it only applies when the same-day E\/M reflects a separate clinical decision, not the visit that led to the drainage<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<p class=\"wp-block-paragraph\">CPT Code 10080 is the CPT code for incision and drainage of a pilonidal cyst, simple, billed when a single, uncomplicated cavity is opened and drained in an office or outpatient setting.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Getting the claim paid on first submission depends on matching the correct ICD-10 diagnosis code, applying the right place-of-service code, and documenting single-cavity findings clearly enough to withstand a payer audit. This guide covers current Medicare reimbursement, ICD-10 pairings, modifiers, documentation requirements, and the most common reasons 10080 claims get denied.<\/p>\n\n\n\n<h2 id=\"h-cpt-code-10080-description-procedure-overview-and-clinical-context\" class=\"wp-block-heading\">CPT Code 10080: Description, procedure overview, and clinical context<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Most pilonidal cyst drainage claims denied on first submission share a single root cause: the documentation does not clearly distinguish a simple procedure from a complicated one. CPT Code 10080 is specific to the simple incision and drainage of a pilonidal cyst, and payers scrutinize it closely against its companion code, 10081.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">According to the <a href=\"https:\/\/www.ama-assn.org\/practice-management\/cpt\/cpt-code-set-overview\" target=\"_blank\" rel=\"nofollow noopener\">American Medical Association (AMA) CPT code set<\/a>, CPT Code 10080 describes: <strong>Incision and drainage of pilonidal cyst; simple.<\/strong> It sits within the Integumentary System subsection of the Surgery chapter (codes 10000-19999), specifically under the Incision and Drainage of Skin, Subcutaneous, and Accessory Structures grouping.<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe title=\"CPT Coding Pitfalls Every Medical Practice Faces\" width=\"800\" height=\"450\" src=\"https:\/\/www.youtube.com\/embed\/vbvV5okdXKg?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">A pilonidal cyst forms in the cleft of the buttocks near the coccyx, typically containing hair and skin debris. When infected, it becomes a pilonidal abscess requiring surgical drainage.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">CPT Code 10080 covers the straightforward version of this procedure: a single incision, drainage of the abscess cavity, and wound packing. There is no extensive sinus tract removal, no multiple cavity exploration, and no packing of a complex network of sinuses.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Field<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Detail<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">CPT Code<\/td>\n<td style=\"padding:12px 16px;color:#374151\">10080<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Official descriptor<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Incision and drainage of pilonidal cyst; simple<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Code category<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Surgery \/ Integumentary System<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Global period<\/td>\n<td style=\"padding:12px 16px;color:#374151\">10 days (minor procedure &#8211; verify current designation in MPFS)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Primary ICD-10 pairings<\/td>\n<td style=\"padding:12px 16px;color:#374151\">L05.01, L05.91<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Companion code<\/td>\n<td style=\"padding:12px 16px;color:#374151\">10081 (complicated I&#038;D)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<h2 id=\"h-cpt-10080-vs-cpt-10081-simple-vs-complicated-pilonidal-cyst-i-amp-d\" class=\"wp-block-heading\">CPT 10080 vs CPT 10081: Simple vs complicated pilonidal cyst I&amp;D<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The distinction between 10080 and 10081 is the most audited coding decision in pilonidal cyst billing. Upcoding 10080 to 10081 without documentation support is a frequent target of payer and compliance audits.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">CPT 10081 (incision and drainage of pilonidal cyst; complicated) applies when the procedure involves multiple sinus tract openings, extensive undermining, packing of a complex cavity network, or a procedure requiring substantially more surgical effort than a simple drainage. The operative note must describe these findings explicitly. &#8222;Large cyst&#8220; alone does not qualify as complicated.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Criterion<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">CPT 10080 (Simple)<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">CPT 10081 (Complicated)<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Sinus tracts<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Single, straightforward cavity<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Multiple tracts or extensive network<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Operative complexity<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Incision, drain, pack &#8211; straightforward<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Undermining, multiple drainage sites, complex packing<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Documentation trigger<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Single cavity noted; no extensive undermining<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Multiple cavities, tracts, or unusual extent described<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Typical setting<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Office or outpatient clinic<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Often ambulatory surgery center or hospital outpatient<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Audit risk<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Low, when documented correctly<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Higher &#8211; requires detailed operative note justification<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">When in doubt, bill 10080. If the procedure was genuinely more complex, the operative note must say so in clinical terms before 10081 can withstand audit scrutiny. If the operative note instead describes excision of the cyst and its sinus tract rather than simple drainage, 11770-11772 is the correct code family, not 10080 or 10081.<\/p>\n\n\n\n<h2 id=\"h-cpt-code-10080-reimbursement-rates-and-rvus\" class=\"wp-block-heading\">CPT Code 10080 reimbursement rates and RVUs<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Medicare reimbursement for CPT Code 10080 is calculated from the Relative Value Unit (RVU) components published in the <a href=\"https:\/\/www.cms.gov\/medicare\/physician-fee-schedule\/search\/overview\" target=\"_blank\" rel=\"nofollow noopener\">CMS Physician Fee Schedule lookup tool<\/a>. All dollar amounts below reflect CY 2026 national averages, sourced from the CMS Physician Fee Schedule Relative Value Files, and should be verified against the current fee schedule year, as rates update annually on January 1.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">RVU Component<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:center;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Non-Facility<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:center;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Facility<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Work RVU (wRVU)<\/td>\n<td style=\"padding:12px 16px;text-align:center;color:#374151\">1.19<\/td>\n<td style=\"padding:12px 16px;text-align:center;color:#374151\">1.19<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Practice Expense RVU (PE)<\/td>\n<td style=\"padding:12px 16px;text-align:center;color:#374151\">6.68<\/td>\n<td style=\"padding:12px 16px;text-align:center;color:#374151\">1.76<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Malpractice RVU (MP)<\/td>\n<td style=\"padding:12px 16px;text-align:center;color:#374151\">0.20<\/td>\n<td style=\"padding:12px 16px;text-align:center;color:#374151\">0.20<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Total RVUs<\/td>\n<td style=\"padding:12px 16px;text-align:center;color:#374151\">8.07<\/td>\n<td style=\"padding:12px 16px;text-align:center;color:#374151\">3.15<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Approx. Medicare payment<\/td>\n<td style=\"padding:12px 16px;text-align:center;color:#374151\">~$270<\/td>\n<td style=\"padding:12px 16px;text-align:center;color:#374151\">~$105<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">The non-facility rate is substantially higher because practice expense RVUs account for the overhead of performing the procedure in your office. When the procedure happens in a hospital outpatient department or ambulatory surgery center, those overhead costs shift to the facility, and the physician receives only the lower facility rate.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Use the <a href=\"https:\/\/fastrvu.com\/tools\/rvu-lookup\" target=\"_blank\" rel=\"nofollow noopener\">FastRVU lookup tool<\/a> to verify current CY-specific values and apply your geographic practice cost index (GPCI) adjustment. Payment estimates above are national averages before GPCI adjustment; actual reimbursement varies by locality.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">With <a href=\"https:\/\/pabau.com\/industry\/plastic-surgery-emr\/\">plastic surgery practice software<\/a>, graft and flap procedures carry their full documentation trail from consult to closure.<\/p>\n\n\n\n<h2 id=\"h-icd-10-diagnosis-codes-paired-with-cpt-10080\" class=\"wp-block-heading\">ICD-10 diagnosis codes paired with CPT 10080<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Selecting the correct ICD-10-CM diagnosis code is the single most consequential documentation decision for CPT 10080 claims. The wrong code at the L05 level triggers automatic denial from most commercial payers and Medicare. Consistent diagnosis-procedure pairing is one of the levers healthcare revenue cycle management depends on to keep first-pass claim acceptance high.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">ICD-10-CM Code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Description<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">When to Use<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">L05.01<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Pilonidal cyst with abscess<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Active infection with purulent drainage present at time of I&#038;D &#8211; the most common pairing<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">L05.91<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Pilonidal cyst without mention of abscess<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Cyst present, drainage performed, but no frank abscess documented; less common for acute I&#038;D<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">L05.02<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Pilonidal sinus with abscess<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Sinus tract (not isolated cyst) with active infection &#8211; less common but clinically relevant<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">L05.92<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Pilonidal sinus without mention of abscess<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Sinus tract present, no acute infection &#8211; rare in the context of CPT 10080<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>L05.01 is the correct code for the overwhelming majority of CPT 10080 claims.<\/strong> The procedure is typically performed because of an abscess. If the operative note says &#8222;pilonidal cyst with purulent drainage&#8220; but the claim is submitted with L05.91, expect a denial or a request for records. The clinical documentation must match the diagnosis code submitted.<\/p>\n\n\n\n<h2 id=\"h-modifiers-for-cpt-code-10080\" class=\"wp-block-heading\">Modifiers for CPT Code 10080<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">CPT Code 10080 has a 10-day global period. Any evaluation or management service provided within that window without a separate, documented unrelated reason will be bundled into the procedure payment unless a modifier is attached. The same bundling logic applies to other integumentary excision codes.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Modifier<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Name<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">When to Apply<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">25<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Significant, separately identifiable E\/M<\/td>\n<td style=\"padding:12px 16px;color:#374151\">E\/M service performed same day as 10080 for a separate, distinct clinical decision<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">24<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Unrelated E\/M during postop period<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Follow-up visit within the 10-day global for an unrelated condition<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">58<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Staged or related procedure during postop<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Planned return procedure within the global period (e.g., repacking)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">76<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Repeat procedure, same physician<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Same procedure repeated on same patient, same day or different day<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">59<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Distinct procedural service<\/td>\n<td style=\"padding:12px 16px;color:#374151\">10080 billed alongside another procedure that would otherwise be bundled &#8211; use only when no more specific modifier applies<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Modifier 25 is the most frequently needed modifier with CPT Code 10080. If the same-day E\/M service was for evaluation of the pilonidal cyst itself, leading directly to the decision to drain, that E\/M is typically bundled.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Modifier 25 applies only when a genuinely separate clinical decision was made during the same encounter. Verify the payer&#8217;s modifier policy before billing, since some commercial payers apply stricter bundling edits than Medicare.<\/p>\n\n\n\n<h2 id=\"h-documentation-requirements-for-cpt-10080\" class=\"wp-block-heading\">Documentation requirements for CPT 10080<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Inadequate documentation is the most common reason CPT 10080 claims fail on appeal. The operative or procedure note must support both the procedure performed and the diagnosis code selected. Good medical record documentation practices are essential for any surgical or procedural service billing. For HIPAA-compliant medical documentation, records must be contemporaneous and retrievable.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The procedure note for CPT 10080 should include all of the following elements:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Location of the cyst:<\/strong> sacrococcygeal area, intergluteal cleft, or specific anatomical position<\/li>\n\n\n\n<li><strong>Pre-procedure assessment:<\/strong> physical examination findings including size, fluctuance, erythema, or purulence<\/li>\n\n\n\n<li><strong>Anesthesia used:<\/strong> local anesthetic type and quantity (e.g., lidocaine 1% with epinephrine)<\/li>\n\n\n\n<li><strong>Incision description:<\/strong> length, direction, and instrument used<\/li>\n\n\n\n<li><strong>Drainage details:<\/strong> character of drainage (purulent, serosanguineous), estimated volume, and odor if relevant<\/li>\n\n\n\n<li><strong>Cavity exploration:<\/strong> single cavity confirmed; no extension, no multiple tracts (this is what distinguishes simple from complicated)<\/li>\n\n\n\n<li><strong>Wound management:<\/strong> irrigation, packing material placed (e.g., iodoform gauze), wound left open or partially closed<\/li>\n\n\n\n<li><strong>Post-procedure plan:<\/strong> wound care instructions, follow-up timing, packing removal instructions<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Use digital clinical forms to standardize procedure note capture and ensure no element is omitted at the point of care. Practices using structured templates for minor surgical procedures see fewer payer requests for records on these claims.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/cpt-code-10080\/digital-forms.webp\" alt=\"Digital forms\"\/><figcaption class=\"wp-element-caption\"><em>Digital forms<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:20px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n        <div id=\"pro_tip\">\n            <div class=\"img\">\n                <svg width=\"42\" height=\"42\" viewBox=\"0 0 42 42\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M12.6383 19.5238C12.6632 21.2071 12.8734 22.9926 12.0685 24.5523C11.0341 26.8917 8.45076 28.169 7.56292 30.5918C6.63082 33.1061 7.19505 36.185 9.31371 37.9786C10.929 39.5678 13.4183 39.9873 15.6061 39.5463C17.4592 39.073 19.1049 37.8388 19.9706 36.1608C20.781 34.7141 20.7866 32.9904 20.5293 31.3985C20.1006 29.3092 18.3775 27.8705 16.9807 26.362C14.8814 24.1005 14.6684 20.6854 15.595 17.8915C16.4331 15.4768 19.0026 14.2344 20.0425 11.9461C20.7202 10.6769 20.7506 9.20327 20.6068 7.81304C20.1864 5.40098 18.3139 3.23631 15.8716 2.56674C13.9742 2.03969 11.8224 2.30052 10.1739 3.37614C8.70522 4.34688 7.5878 5.86618 7.28356 7.58178C6.76081 9.82981 7.53525 12.2822 9.20307 13.9118C10.7658 15.4741 12.4806 17.2273 12.6383 19.5238Z\"\n                        fill=\"#2BADD4\" \/>\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M22.7048 19.8387C22.6822 22.3279 24.4507 24.6234 26.7493 25.4682C28.0531 25.961 29.4725 25.9183 30.7989 25.5487C32.0575 24.9955 33.301 24.2237 34.0069 23.0092C34.8384 21.5811 35.2982 19.8286 34.7832 18.2094C34.3611 16.2507 32.8739 14.6541 31.0275 13.9426C28.6736 12.9595 25.8073 13.7942 24.1719 15.7001C23.2022 16.8366 22.6143 18.3326 22.7048 19.8387Z\"\n                        fill=\"#2BADD4\" \/>\n                <\/svg>\n            <\/div>\n            <div class=\"text\">\n                <h3>Pro Tip<\/h3>\n                <p>Document the phrase &#8217;single cavity, no extension or multiple sinus tracts&#8216; explicitly in every CPT 10080 procedure note. This one sentence protects against upcoding allegations and eliminates the most common payer records request for this code.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-place-of-service-and-facility-vs-non-facility-billing\" class=\"wp-block-heading\">Place of service and facility vs non-facility billing<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Where you perform CPT Code 10080 directly determines your Medicare reimbursement rate. This is one of the most underappreciated billing variables for minor procedure codes, and getting it wrong means submitting claims at the wrong rate.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Practice management software like Pabau, including skin clinic practice software, keeps place-of-service and billing details attached to the same patient record so front-desk and billing staff work from one source of truth.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Setting<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">POS Code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Rate Applied<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Who Gets PE RVUs<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Physician office<\/td>\n<td style=\"padding:12px 16px;color:#374151\">11<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Non-facility (higher)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Physician practice<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Hospital outpatient<\/td>\n<td style=\"padding:12px 16px;color:#374151\">22<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Facility (lower)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Hospital (billed separately)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Ambulatory surgery center<\/td>\n<td style=\"padding:12px 16px;color:#374151\">24<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Facility (lower)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">ASC (billed separately)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Urgent care (non-facility)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">20<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Non-facility (higher)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Practice\/urgent care entity<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">An urgent care center that is not hospital-owned typically uses POS 20 and bills at the non-facility rate. A physician employed by a hospital system performing the same procedure in a clinic owned by the hospital may be required to use POS 22, dropping the physician payment to the facility rate.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Confirm your facility&#8217;s CMS enrollment type before setting default POS codes in your billing system. Family practice and urgent care software like Pabau lets each location store its own default POS code, reducing the chance of an entry error when scheduling these encounters.<\/p>\n\n\n        <div id=\"book_a_demo\">\n            <div class=\"left-side\">\n                <div class=\"logo\">\n                    <img decoding=\"async\"\n                        src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Logo.svg\"\n                        alt=\"Logo\"\n                        loading=\"lazy\"\n                    \/>\n                <\/div>\n\n                <h3 class=\"heading\">\n                    Keep billing and patient records in one place                <\/h3>\n\n                <p class=\"description\">\n                    Pabau is practice management software that keeps scheduling, documentation, and billing in a single patient record, so the details that drive correct coding are never scattered across separate systems.                <\/p>\n\n                <div class=\"button-group\">\n                    <a href=\"\/book-demo\/\" class=\"btn btn-scale-effect btn-cta-color btn-md\">\n                        <span class=\"btn-text\">Book a demo<\/span>\n                        <div class=\"btn-icon btn-icon-right\" aria-hidden=\"true\">\n                            <svg\n                                width=\"14\"\n                                height=\"12\"\n                                viewBox=\"0 0 14 12\"\n                                fill=\"none\"\n                                xmlns=\"http:\/\/www.w3.org\/2000\/svg\"\n                            >\n                                <path\n                                    d=\"M0.75 4.77295C0.335786 4.77295 0 5.10874 0 5.52295C0 5.93716 0.335786 6.27295 0.75 6.27295V5.52295V4.77295ZM13.2803 6.05328C13.5732 5.76039 13.5732 5.28551 13.2803 4.99262L8.50736 0.219648C8.21447 -0.073245 7.73959 -0.073245 7.4467 0.219648C7.15381 0.512542 7.15381 0.987415 7.4467 1.28031L11.6893 5.52295L7.4467 9.76559C7.15381 10.0585 7.15381 10.5334 7.4467 10.8263C7.73959 11.1191 8.21447 11.1191 8.50736 10.8263L13.2803 6.05328ZM0.75 5.52295V6.27295L12.75 6.27295V5.52295V4.77295L0.75 4.77295V5.52295Z\"\n                                    fill=\"currentColor\"\n                                ><\/path>\n                            <\/svg>\n                        <\/div>\n                    <\/a>\n                <\/div>\n            <\/div>\n\n            <div class=\"right-side\">\n                <img decoding=\"async\"\n                    src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Home-Page-Concept-4.webp\"\n                    alt=\"Pabau practice management dashboard\"\n                    loading=\"lazy\"\n                \/>\n            <\/div>\n        <\/div>\n        \n\n\n<h2 id=\"h-common-billing-errors-and-denial-reasons-for-cpt-10080\" class=\"wp-block-heading\">Common billing errors and denial reasons for CPT 10080<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Denial patterns for pilonidal cyst I&amp;D claims cluster around a predictable set of documentation and coding errors. Knowing these patterns in advance is more efficient than rebuilding appeals after the fact. Practices billing from a single system have fewer opportunities for these errors to slip through, since the same record holds the diagnosis, procedure, and place-of-service data together.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/cpt-code-10080\/automate-claims-through-healthcode.webp\" alt=\"Automate claims and billing with Pabau\"\/><figcaption class=\"wp-element-caption\"><em>Automate claims and billing with Pabau<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:20px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Wrong ICD-10 specificity:<\/strong> Billing L05.91 when the procedure note describes purulent drainage. L05.01 is required when abscess is present. This is the single most common denial trigger.<\/li>\n\n\n\n<li><strong>Missing single-cavity documentation:<\/strong> The note says &#8222;pilonidal cyst drained&#8220; without specifying single cavity. Payers request records, and the claim ages in AR.<\/li>\n\n\n\n<li><strong>Unbundled E\/M without modifier 25:<\/strong> Billing both an office visit and 10080 on the same date without modifier 25. Most payers auto-deny the E\/M.<\/li>\n\n\n\n<li><strong>Incorrect POS code:<\/strong> Billing POS 11 when the procedure was performed in a hospital-owned clinic. The payer sees the facility&#8217;s UB-04 claim and identifies the duplicate.<\/li>\n\n\n\n<li><strong>Upcoding scrutiny on 10081:<\/strong> If 10080 was initially billed and later corrected to 10081 without a contemporaneous operative note supporting complexity, expect heightened audit scrutiny.<\/li>\n\n\n\n<li><strong>Global period violations:<\/strong> Billing a follow-up E\/M within the 10-day global without modifier 24 or 58. These are automatically denied or bundled.<\/li>\n\n\n\n<li><strong>Missing ICD-10 link on secondary procedure:<\/strong> When 10080 is billed alongside another integumentary code, each code needs its own supporting diagnosis. Shared diagnosis codes without NCCI modifier compliance trigger edits.<\/li>\n<\/ul>\n\n\n\n<h2 id=\"h-cpt-code-10080-and-medicare-coverage-policies-and-lcd-considerations\" class=\"wp-block-heading\">CPT Code 10080 and Medicare: Coverage policies and LCD considerations<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Medicare covers CPT Code 10080 when medical necessity is established through the diagnosis code and supporting documentation. The procedure is not subject to a National Coverage Determination (NCD) that restricts its use.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Individual Medicare Administrative Contractors (MACs) may have issued Local Coverage Determinations (LCDs) for integumentary procedures in their jurisdictions. Check your MAC&#8217;s LCD database before billing for Medicare patients, since coverage requirements can vary by region.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Key Medicare-specific considerations for CPT 10080:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Prior authorization:<\/strong> Medicare Fee-for-Service does not require prior authorization for CPT 10080. Medicare Advantage plans may require it, so verify with each plan individually.<\/li>\n\n\n\n<li><strong>Advance Beneficiary Notice (ABN):<\/strong> Not typically required for CPT 10080 when documentation supports medical necessity. If there is any question about medical necessity (e.g., the cyst is not infected), obtain an ABN before the procedure.<\/li>\n\n\n\n<li><strong>Deductible and coinsurance:<\/strong> Subject to the Part B deductible and 20% coinsurance. The procedure falls under standard Part B surgical benefit.<\/li>\n\n\n\n<li><strong>Medically unlikely edits (MUEs):<\/strong> CMS assigns a per-day billing unit limit. For CPT 10080, the MUE is typically 1 &#8211; billing it twice on the same date requires documentation justification and modifier 76 (same physician) or 77 (different physician) depending on circumstance.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">For Medicaid, reimbursement rates and coverage requirements vary significantly by state. Verify with your state Medicaid program for current rate schedules and any prior authorization requirements. The <a href=\"https:\/\/www.cms.gov\/medicare\/coding-billing\/icd-10-codes\" target=\"_blank\" rel=\"nofollow noopener\">CMS ICD-10 codes reference page<\/a> provides current coding and coverage guidance applicable to Medicare claims.<\/p>\n\n\n\n<h2 id=\"h-related-cpt-codes-10060-10061-10081-and-other-i-amp-d-codes\" class=\"wp-block-heading\">Related CPT codes: 10060, 10061, 10081, and other I&amp;D codes<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">CPT Code 10080 sits within a broader family of incision and drainage codes. Correct code selection requires understanding how each code differs clinically and operationally. The <a href=\"https:\/\/www.aapc.com\/codes\/cpt-codes-range\/\" target=\"_blank\" rel=\"nofollow noopener\">AAPC Codify CPT lookup<\/a> provides full descriptors and crosswalk information for this code family.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">When the wound is closed with sutures instead of left open and packed, code selection shifts away from an incision-and-drainage code entirely. <\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">CPT Code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Descriptor<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Key Distinction from 10080<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">10060<\/td>\n<td style=\"padding:12px 16px;color:#374151\">I&#038;D of abscess; simple or single<\/td>\n<td style=\"padding:12px 16px;color:#374151\">General abscess I&#038;D &#8211; not pilonidal-specific; used for cutaneous abscesses elsewhere on the body<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">10061<\/td>\n<td style=\"padding:12px 16px;color:#374151\">I&#038;D of abscess; complicated or multiple<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Complicated or multiple non-pilonidal abscess; general integumentary<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">10080<\/td>\n<td style=\"padding:12px 16px;color:#374151\">I&#038;D of pilonidal cyst; simple<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Pilonidal-specific, single cavity, straightforward drainage<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">10081<\/td>\n<td style=\"padding:12px 16px;color:#374151\">I&#038;D of pilonidal cyst; complicated<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Pilonidal-specific, multiple tracts or complex cavity, higher operative burden<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">10040<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Acne surgery<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Opening of acne lesions; different anatomical and clinical context entirely<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">CPT Code 10060 is frequently confused with CPT 10080. Use 10060 for cutaneous abscesses at any other body location. Use 10080 only when the abscess is specifically a pilonidal cyst in the sacrococcygeal\/intergluteal region.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Using 10060 for a pilonidal cyst will be flagged on clinical review. The ICD-10-CM diagnosis code (L05.x) is anatomically specific and will not crosswalk correctly to a general integumentary abscess CPT code in many payer edits.<\/p>\n\n\n        <div id=\"pro_tip\">\n            <div class=\"img\">\n                <svg width=\"42\" height=\"42\" viewBox=\"0 0 42 42\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M12.6383 19.5238C12.6632 21.2071 12.8734 22.9926 12.0685 24.5523C11.0341 26.8917 8.45076 28.169 7.56292 30.5918C6.63082 33.1061 7.19505 36.185 9.31371 37.9786C10.929 39.5678 13.4183 39.9873 15.6061 39.5463C17.4592 39.073 19.1049 37.8388 19.9706 36.1608C20.781 34.7141 20.7866 32.9904 20.5293 31.3985C20.1006 29.3092 18.3775 27.8705 16.9807 26.362C14.8814 24.1005 14.6684 20.6854 15.595 17.8915C16.4331 15.4768 19.0026 14.2344 20.0425 11.9461C20.7202 10.6769 20.7506 9.20327 20.6068 7.81304C20.1864 5.40098 18.3139 3.23631 15.8716 2.56674C13.9742 2.03969 11.8224 2.30052 10.1739 3.37614C8.70522 4.34688 7.5878 5.86618 7.28356 7.58178C6.76081 9.82981 7.53525 12.2822 9.20307 13.9118C10.7658 15.4741 12.4806 17.2273 12.6383 19.5238Z\"\n                        fill=\"#2BADD4\" \/>\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M22.7048 19.8387C22.6822 22.3279 24.4507 24.6234 26.7493 25.4682C28.0531 25.961 29.4725 25.9183 30.7989 25.5487C32.0575 24.9955 33.301 24.2237 34.0069 23.0092C34.8384 21.5811 35.2982 19.8286 34.7832 18.2094C34.3611 16.2507 32.8739 14.6541 31.0275 13.9426C28.6736 12.9595 25.8073 13.7942 24.1719 15.7001C23.2022 16.8366 22.6143 18.3326 22.7048 19.8387Z\"\n                        fill=\"#2BADD4\" \/>\n                <\/svg>\n            <\/div>\n            <div class=\"text\">\n                <h3>Pro Tip<\/h3>\n                <p>Run a quarterly claim audit: pull all 10080 claims and check the paired ICD-10 code. L05.01 should account for at least 80% of them. If L05.91 is appearing frequently, review whether diagnosis documentation is being written before or after procedures.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 class=\"wp-block-heading\">Related CPT codes<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-10005\/\">CPT code 10005 \u2014 Fine Needle Aspiration Biopsy with Ultrasound Guidance<\/a><\/li>\n\n\n<li><a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-10081\/\">CPT Code 10081 \u2014 Incision and drainage of pilonidal cyst<\/a><\/li>\n\n\n<li><a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-10120\/\">CPT Code 10120 \u2014 Incision and removal of foreign body, subcutaneous<\/a><\/li>\n\n\n<li><a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-10140\/\">CPT Code 10140 \u2014 Incision and drainage of hematoma, seroma, or<\/a><\/li>\n<\/ul>\n\n\n\n<h2 id=\"h-conclusion\" class=\"wp-block-heading\">Conclusion<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Most CPT 10080 claim problems come down to two things: ICD-10 specificity (L05.01 vs L05.91) and missing single-cavity language in the procedure note. Both are preventable at the point of care.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Practices that keep scheduling, documentation, and billing in one system, such as Pabau, give front-desk and billing staff a single, consistent record to work from, rather than reconciling diagnosis, procedure, and place-of-service details across separate tools.<\/p>\n\n\n        <div id=\"expert_picks\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/11\/Expert-Picks.svg\" alt=\"Continue your research\" height=\"42\" width=\"42\">\n                                <h3>Continue your research<\/h3>\n            <\/div>\n            <div class=\"content\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Need a billing compliance overview for your practice type?<\/strong> <a href=\"https:\/\/pabau.com\/blog\/hipaa-compliance-for-clinic-software\/\" rel=\"noopener\">HIPAA compliance for clinic software<\/a> covers the documentation and record-keeping requirements that underpin clean claim submission.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Billing for a related surgical wound repair code?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-15101\/\" rel=\"noopener\">CPT Code 15101 split-thickness autograft billing guide<\/a> walks through reimbursement and documentation for a comparable integumentary procedure.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Want to reduce documentation burden at the point of care?<\/strong> <a href=\"https:\/\/pabau.com\/features\/ai-medical-scribe\/\" rel=\"noopener\">Pabau Scribe, our AI scribe<\/a> structures procedure notes automatically, reducing the manual effort required to produce audit-ready records.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-frequently-asked-questions\" class=\"wp-block-heading\">Frequently asked questions<\/h2>\n\n\n\n<div class=\"schema-faq wp-block-yoast-faq-block\"><div class=\"schema-faq-section\" id=\"faq-question-1784878287904\"><h3 class=\"schema-faq-question\">What does CPT Code 10080 mean?<\/h3> <p class=\"schema-faq-answer\">CPT Code 10080 is &#8222;Incision and drainage of pilonidal cyst; simple,&#8220; a surgical procedure code maintained by the American Medical Association used to bill for straightforward drainage of an infected pilonidal cyst in the sacrococcygeal region. It covers single-cavity incision and drainage without extensive sinus tract involvement.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1784878287905\"><h3 class=\"schema-faq-question\">What is the difference between CPT 10080 and CPT 10081?<\/h3> <p class=\"schema-faq-answer\">CPT 10080 (simple) applies to single-cavity, straightforward pilonidal cyst drainage. CPT 10081 (complicated) applies when the procedure involves multiple sinus tracts, extensive undermining, or a substantially higher operative burden documented in the procedure note. &#8222;Large cyst&#8220; alone does not qualify a case for 10081.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1784878287906\"><h3 class=\"schema-faq-question\">Is CPT Code 10080 covered by Medicare?<\/h3> <p class=\"schema-faq-answer\">Yes, Medicare Part B covers CPT Code 10080 when medical necessity is supported by an appropriate ICD-10-CM diagnosis code (typically L05.01). Medicare Advantage plans may require prior authorization; standard Medicare Fee-for-Service does not. Coverage policies may vary by MAC jurisdiction, so verify with your regional MAC.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1784878287907\"><h3 class=\"schema-faq-question\">What ICD-10 code pairs with CPT 10080?<\/h3> <p class=\"schema-faq-answer\">L05.01 (pilonidal cyst with abscess) is the primary pairing for most CPT 10080 claims because the procedure is typically performed for an infected, abscessed cyst. L05.91 (pilonidal cyst without abscess) applies in cases where drainage is performed without frank abscess documentation.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1784878287908\"><h3 class=\"schema-faq-question\">What modifiers can be used with CPT 10080?<\/h3> <p class=\"schema-faq-answer\">Modifier 25 is the most common, applied when a separately identifiable E\/M service is performed the same day. Modifier 24 covers unrelated E\/M services within the 10-day global period. Modifier 58 applies to staged or planned procedures within the global. Modifier 76 is used for a repeat procedure by the same physician.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1784878287909\"><h3 class=\"schema-faq-question\">Has CPT 10080 been deleted or replaced?<\/h3> <p class=\"schema-faq-answer\">CPT Code 10080 remains active as of the current AMA CPT edition. Verify its status in the current AMA CPT codebook annually, as CPT descriptors and code assignments are subject to revision. Always confirm active status before billing any code you have not used recently.<\/p> <\/div> <\/div>\n","protected":false},"excerpt":{"rendered":"<p>CPT Code 10080 is the CPT code for incision and drainage of a pilonidal cyst, simple, billed when a single, uncomplicated cavity is opened and drained in an office or outpatient setting. Getting the claim paid on first submission depends on matching the correct ICD-10 diagnosis code, applying the right place-of-service code, and documenting single-cavity [&hellip;]<\/p>\n","protected":false},"author":77,"featured_media":163576,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_yoast_wpseo_linkdex":"91","_yoast_wpseo_content_score":"30","_yoast_wpseo_is_cornerstone":"","_yoast_wpseo_keywordsynonyms":"[\"\",\"\",\"\",\"\"]","_yoast_wpseo_focuskw_text_input":"","_seo_original_html":"","footnotes":""},"categories":[1433,1546],"tags":[1364,2387,4102,1602,2508,1233,1236],"class_list":["post-163577","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-billing-codes","category-cpt-codes","tag-billing","tag-claim-denials","tag-cpt-code","tag-cpt-modifiers","tag-medical-coding","tag-medicare-cpt-codes","tag-medicare-reimbursement"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v28.2 (Yoast SEO v28.2) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>CPT Code 10080 Billing Guide: 2026 Medicare Rates<\/title>\n<meta name=\"description\" content=\"CPT Code 10080 billing guide: 2026 Medicare RVUs and reimbursement, correct ICD-10 pairings, modifiers, and common denial reasons explained.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/pabau.com\/de\/procedure-codes\/cpt-code-10080\/\" \/>\n<meta property=\"og:locale\" content=\"de_DE\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"CPT Code 10080 Billing Guide: 2026 Medicare Rates\" \/>\n<meta property=\"og:description\" content=\"CPT Code 10080 billing guide: 2026 Medicare RVUs and reimbursement, correct ICD-10 pairings, modifiers, and common denial reasons explained.\" \/>\n<meta property=\"og:url\" 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