CPT 11730Surgery

Removal of nail plate

CPT code 11730 covers the surgical removal of a fingernail or toenail plate, typically performed when a nail is severely damaged, infected, or causing chronic pain. This is different from simply trimming a nail—it involves removing the entire visible nail plate from the nail bed.

Showing rates for

National Average

Base Medicare rate

$110.63

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

1.05

PE RVU (NF)

2.29

MP RVU

0.08

Total RVU

3.42

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

NCCI bundling edits

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Billing tips

Always verify place of service code: use POS 11 (office) for non-facility rate ($110.63) versus POS 22 (outpatient hospital) or POS 24 (ASC) for facility rate ($52.08)
Impact: Incorrect POS coding results in $58.55 underpayment per procedure when office-based procedures are incorrectly filed as facility
Append anatomical modifiers (TA, T1-T9, FA, F1-F9) for every nail removal to specify exact digit; multiple nail removals require separate line items with distinct modifiers
Impact: Missing modifiers result in denial of additional nail procedures beyond the first; proper coding can increase reimbursement by 100-500% when multiple nails are removed
Do not confuse 11730 with 11750 (permanent nail removal with matrix destruction); 11730 allows nail regrowth while 11750 is ablative
Impact: Code substitution may trigger audit flags; 11750 reimburses at $149.26 non-facility, $38.74 higher than 11730, making upcoding a fraud risk
When billing with E/M code on same date, modifier 25 on E/M requires documentation of separate medical decision-making beyond the decision to perform the procedure
Impact: Proper modifier 25 documentation can preserve $75-200 in E/M reimbursement; inadequate documentation results in E/M denial
For bilateral procedures on same toe (e.g., both great toes), use modifier 50 rather than billing two separate line items; verify payer-specific bilateral policies
Impact: Modifier 50 typically yields 150% payment ($165.95) vs. potential denials or 100% payment if billed on separate lines without proper modifiers
Submit clear operative notes documenting pre-procedure assessment, anesthesia type and amount, removal technique, hemostasis method, and post-procedure wound care instructions

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 11730 in 2025?

The 2025 Medicare national average reimbursement for CPT 11730 is $110.63 for non-facility settings (office/clinic) and $52.08 for facility settings (hospital outpatient or ASC). Actual payment may vary by locality based on GPCI adjustments and MAC-specific policies.

Can I bill CPT 11730 for multiple toenails on the same day?

Yes, you can bill 11730 for multiple nail removals on the same date by submitting separate line items with appropriate anatomical modifiers (TA, T1-T9 for toes; FA, F1-F9 for fingers). Each nail removal should be documented separately in the operative note with specific digit identification.

What is the difference between CPT 11730 and 11750?

CPT 11730 is simple nail plate removal that allows the nail to grow back, while CPT 11750 includes permanent nail removal with destruction of the nail matrix to prevent regrowth. Code 11750 is used for permanent ablation procedures and reimburses at a higher rate ($149.26 non-facility vs. $110.63 for 11730).

Do I need modifier 25 when billing an office visit with CPT 11730?

Modifier 25 is required on the E/M code only when you provide a significant, separately identifiable evaluation and management service beyond the typical pre-procedure assessment. The documentation must show distinct medical decision-making, such as evaluating other conditions or addressing concerns unrelated to the nail removal decision.

What diagnosis codes support medical necessity for CPT 11730?

Common supporting diagnoses include L60.0 (ingrown nail), B35.1 (tinea unguium/onychomycosis), S90-S99 series (toe injuries), L03.03- (cellulitis of toe), L60.3 (nail dystrophy), and L60.8 (other nail disorders). Documentation must show failed conservative treatment or acute medical indication for removal.

How many RVUs is CPT code 11730 worth in 2025?

CPT 11730 has a total RVU value of 3.42 in 2025, composed of 1.05 work RVUs, 2.29 non-facility practice expense RVUs (0.48 facility PE RVUs), and 0.08 malpractice RVUs. These values are multiplied by the 2025 conversion factor of 32.3465 to determine payment.

Is CPT 11730 covered by Medicare for fungal nail infections?

Medicare covers 11730 for onychomycosis (fungal nail infections) when medically necessary, typically requiring documentation of failed antifungal treatment, significant pain or functional impairment, or contraindications to oral antifungals. Simple cosmetic concerns or asymptomatic fungal nails may not meet medical necessity criteria and could be denied.