Summary & Overview
CPT 11730: Avulsion of Nail Plate, Partial or Complete, Single
Headline: CPT 11730 — Simple Single Nail Plate Avulsion, Common Dermatologic Office Procedure
Lead: CPT 11730 documents a simple partial or complete avulsion of a single nail plate performed in an outpatient dermatology setting. It is a widely used code for treating nail conditions that require removal of the nail plate and is relevant across payers and clinical practices.
What this code represents and why it matters: CPT 11730 captures a common, low-complexity dermatologic surgical procedure. Accurate use of the code affects clinical documentation, billing consistency, and claims adjudication for nail-related procedures performed in office settings. Its application is important for appropriate payment and for distinguishing this service from more complex nail excisions and reconstructive procedures.
Key payers covered: This summary addresses coverage considerations for Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
What readers will learn: The publication provides benchmarks for coding and billing CPT 11730, explains relevant clinical contexts in which the code is used, and compares related procedural codes to clarify when CPT 11730 is the appropriate code versus add-on or more extensive nail procedures. It also summarizes common payer considerations and documentation elements needed for claims processing.
Data limitations: Data not available in the input for service line specifics and payer policy details; readers should consult payer policy manuals for definitive coverage rules.
CPT Code Overview
CPT 11730 describes avulsion of nail plate, partial or complete, simple; single. This procedure is classified under dermatologic surgery and involves removal of all or part of a nail plate from a single digit. The typical setting for the service is the outpatient office (POS 11).
Clinical & Coding Specifications
A patient presents to an outpatient dermatology office (POS 11) with a symptomatic nail disorder such as an ingrowing toenail causing pain and localized inflammation. The clinician evaluates the affected digit, documents history and focused exam, and determines that a simple avulsion of the nail plate is indicated. After informed consent, local anesthesia is administered to the digit, and a partial or complete avulsion of the nail plate is performed on a single nail. Hemostasis is achieved, a dressing is applied, and post-procedure wound care and follow-up are documented. The encounter includes identification of the specific digit using an identifying digit modifier when required, and the procedure is coded as 11730.
Modifiers:
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KX: Used when a repeat nail avulsion is performed on the same finger less than 4 months or the same toe less than 8 months and the service is reasonable and necessary. -
identifying digit modifiers: Used to indicate the specific digit on which the procedure is performed (to identify the treated nail).
Provider Taxonomies:
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207NP0225X: Pediatric Dermatology Physician — represents dermatologists with a pediatric focus. -
207NS0135X: Procedural Dermatology Physician — represents dermatologists who perform procedural dermatology including minor surgical procedures.
Notes:
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Use of the listed modifiers is limited to the codes and timeframes provided.
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If additional modifiers or taxonomies are needed for billing, they are not provided in the input.
Related Diagnoses:
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L60.0- Ingrowing nail- Clinical relevance: Ingrowing nails commonly cause pain, inflammation, and infection localized to the nail margin and are a frequent indication for nail plate avulsion (
11730) to relieve the acute problem.
- Clinical relevance: Ingrowing nails commonly cause pain, inflammation, and infection localized to the nail margin and are a frequent indication for nail plate avulsion (
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L60.1- Onycholysis- Clinical relevance: Separation of the nail plate from the nail bed can cause debris accumulation and secondary symptoms; partial or complete avulsion (
11730) may be performed when conservative management is insufficient.
- Clinical relevance: Separation of the nail plate from the nail bed can cause debris accumulation and secondary symptoms; partial or complete avulsion (
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L60.2- Onychogryphosis- Clinical relevance: Thickened, deformed nails may require nail plate avulsion for symptomatic relief or to prepare for further definitive treatment.
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L60.3- Nail dystrophy- Clinical relevance: General nail dystrophy that causes pain, infection risk, or interferes with function can be an indication for
11730when removal of the nail plate is appropriate.
- Clinical relevance: General nail dystrophy that causes pain, infection risk, or interferes with function can be an indication for
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L60.4- Beau's lines- Clinical relevance: Transverse depressions of the nail plate may be associated with underlying nail pathology;
11730may be used if nail plate removal is clinically indicated for symptomatic or diagnostic reasons.
- Clinical relevance: Transverse depressions of the nail plate may be associated with underlying nail pathology;
Related CPT Codes:
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11732- add-on code for subsequent avulsion- Relationship:
11732is an add-on code reported in conjunction with the primary avulsion when additional separate nail avulsions are performed during the same session on additional nails.
- Relationship:
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11750- excision of nail and nail matrix, partial or complete- Relationship:
11750is a more extensive procedure that removes the nail matrix and is an alternative when permanent nail removal or matricectomy is required.
- Relationship:
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11765- wedge resection (excision of nail fold)- Relationship:
11765addresses pathology of the nail fold and is an alternative or adjunctive procedure when excision of the nail fold is clinically indicated.
- Relationship:
Common usage:
11732is commonly used together with11730when multiple nails are avulsed in the same session (reported as add-on).11750and11765are alternatives or additional procedures depending on the clinical indication and extent of surgery.
National Reimbursement Benchmarks
Medicare mean rates for 11730 sit between the commercial average (BUCA) and the highest commercial payer; Medicare's mean of $115.73 is modestly above the BUCA national commercial mean of $109.22, and below UnitedHealth Group's mean of $151.77.
Rate dispersion varies across payers. The narrowest interquartile spread (P75–P25) is seen with Medicare ($12.00), indicating relatively tight regional variation; Aetna and Blue Cross Blue Shield show moderate spreads ($50.67 and $43.50 respectively). The widest dispersion is UnitedHealth Group ($87.67) and Cigna ($75.50), reflecting larger variability in commercial contract rates. The table and chart below present the full percentile and mean-rate breakdown.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.