CPT 11762Surgery

Reconstruction of nail bed

CPT code 11762 covers the surgical reconstruction of the nail bed, the tissue beneath the fingernail or toenail that supports nail growth. This procedure is performed when the nail bed has been severely damaged by trauma, infection, or previous surgery.

Showing rates for

National Average

Base Medicare rate

$280.77

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

2.94

PE RVU (NF)

5.4

MP RVU

0.34

Total RVU

8.68

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

NCCI bundling edits

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Billing tips

Always append appropriate digit modifier (FA-F9 or TA-T9) as these are required by most payers for anatomic specificity
Impact: Prevents automatic denials and processing delays that can extend payment cycle by 15-30 days; virtually 100% of claims without digit modifiers face initial rejection
Verify place of service carefully - billing in ASC/office (non-facility rate $280.77) versus hospital outpatient (facility rate $184.05) creates $96.72 difference
Impact: Incorrect POS code results in $96.72 underpayment or overpayment requiring refund; verify where procedure actually occurred and patient registration location
Document whether any tissue grafting was performed separately; if split-thickness or full-thickness skin graft used, consider reporting appropriate graft codes (15050, 15100-15101) in addition to 11762
Impact: Proper coding of grafts can add $150-$400 in additional reimbursement when clinically appropriate and documented as separate, additional work beyond basic reconstruction
For trauma cases, link to appropriate injury diagnosis codes (S61.3xx series for finger lacerations, S91.2xx for toe injuries) with 7th character for encounter type
Impact: Improper diagnosis coding or missing 7th character causes denial; using non-specific codes may trigger medical necessity denials requiring appeal and delaying payment 45-60 days
Be aware of the 90-day global period for 11762; evaluation services during this period are generally bundled unless unrelated problem or modifier 24/25 criteria met
Impact: Attempting to bill E/M services during global without proper modifier results in $75-$200 in denied services; conversely, missing billable unrelated E/M loses legitimate revenue

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Frequently asked questions

What is the 2025 Medicare reimbursement rate for CPT code 11762?

The 2025 Medicare national average reimbursement is $280.77 for non-facility settings (office, ASC) and $184.05 for facility settings (hospital outpatient). Actual payment may vary based on geographic location (GPCI adjustments) and payer-specific contracts.

Does CPT 11762 include nail removal or is that billed separately?

CPT 11762 includes any nail removal necessary to access and reconstruct the nail bed. You should not separately bill CPT 11750 (permanent nail removal) or 11732 (avulsion) when performed as part of the reconstruction approach. These services are considered bundled components.

Can I bill 11762 for both fingernail and toenail reconstruction?

Yes, 11762 applies to both fingernails and toenails. You must use appropriate digit modifiers (FA-F9 for fingers, TA-T9 for toes) to specify the exact digit treated. The reimbursement rate is the same regardless of whether it's a finger or toe.

What modifiers are required when billing CPT 11762?

Digit-specific modifiers (FA-F9 for fingers or TA-T9 for toes) are required by most payers. If multiple digits are treated in the same session, use modifier 51 for the second and subsequent procedures. Use modifier 22 only when significantly increased complexity is clearly documented with operative details.

How many RVUs is CPT code 11762 worth in 2025?

CPT 11762 has a total of 8.68 RVUs in 2025: 2.94 work RVUs, 5.4 non-facility practice expense RVUs (2.41 for facility), and 0.34 malpractice RVUs. This represents moderate-complexity surgical work with a 90-day global period.

What diagnosis codes support medical necessity for CPT 11762?

Appropriate diagnoses include traumatic nail bed lacerations (S61.3xx for fingers, S91.2xx for toes), subungual tumors (D23.x, C43.x for melanoma), chronic nail deformities from previous injury (L60.3, L60.8), infections requiring debridement and reconstruction, and congenital nail disorders. Cosmetic indications are not covered.

Can CPT 11762 be billed with skin graft codes on the same digit?

Yes, if you perform a separate, documentable skin graft beyond the basic nail bed reconstruction, you may bill appropriate graft codes (15050 for pinch graft, 15100-15101 for split-thickness) with modifier 59 or XS. Documentation must clearly show the graft was additional work beyond typical nail bed repair and justify medical necessity for both procedures.