CPT Code Overview

CPT 11750 describes the excision of the nail and nail matrix, partial or complete, for permanent removal (for example, ingrown or deformed nails). This procedure is categorized under Surgical Procedures on the Nails and is commonly performed by specialists in dermatology or podiatry. The typical site of service for CPT 11750 is the office (POS 11).

Clinical Context

A 35-year-old patient presents to a dermatology or podiatry office (POS 11) with a chronically ingrown right great toenail causing recurrent pain, inflammation, and localized infection despite conservative care. The clinician documents diagnosis, discusses permanent nail removal, obtains consent, prepares sterile field, administers local anesthesia, performs excision of the nail and nail matrix (partial or complete) to prevent regrowth, achieves hemostasis, and provides postoperative wound care instructions and follow-up.

Coding Specifications

• Common Modifiers:

• 50 — Bilateral procedure: Append when the excision of nail and nail matrix is performed on both corresponding nails (e.g., both great toes) during the same operative session.

• KX — Repeat nail excision on the same finger or toe when medically necessary: Use when documentation supports a medically necessary repeat excision on the same digit and payer requires KX for medical necessity attestation.

• 51 — Multiple procedures: Apply when multiple distinct procedures are reported on the same date of service to indicate multiple procedural services; sequencing and payer rules determine application and payment adjustments.

• 59 — Distinct procedural service: Use to indicate a separate and distinct surgical service on the same digit or toe when bundling edits might otherwise apply; ensure documentation supports distinctness.

• Associated Provider Taxonomies:

• Notes:

• Use modifier selection consistent with payer policies and documented clinical situation.

Related Diagnoses

• S90.211A-S — Open bite of right great toe, initial encounter (and sequela variants)

Clinical relevance: An open bite or traumatic wound of the great toe can involve the nail unit and may necessitate nail excision or matrix removal if the nail or matrix is damaged, infected, or prevents wound healing.

• S90.212A-S — Open bite of left great toe, initial encounter (and sequela variants)

Clinical relevance: Same clinical considerations as the right great toe when the left great toe nail unit is involved and surgical nail removal is required for management.

• S90.221A-S — Open bite of right second toe, initial encounter (and sequela variants)

Clinical relevance: Traumatic open bite of a second toe can involve nail damage or chronic complications leading to need for nail and matrix excision to control infection or promote healing.

• S90.222A-S — Open bite of left second toe, initial encounter (and sequela variants)

Clinical relevance: Left second toe open bite with nail involvement may require 11750 when the nail matrix must be removed to address ongoing pathology or prevent recurrent issues.

Related CPT Codes

• Usage notes:

• 11730/11732 are commonly considered less extensive than 11750 and may be used prior to or instead of matrix excision.

• 11765 addresses soft tissue of the nail fold and may be reported with 11750 if separate anatomic procedures are performed and documentation supports distinct services.

Medicare mean allowed rate is lower than the BUCA (average commercial) mean: Medicare at $163.27 versus BUCA at $194.61, indicating commercial payers generally reimburse more than Medicare for 11750. The gap between Medicare and the highest commercial mean (UnitedHealth Group at $249.28) is substantial.

Rate dispersion (P75 minus P25) varies across payers. The tightest distributions are Medicare (range $17.00) and Aetna (range $95.67 relative to its percentiles), while the widest dispersion appears with UnitedHealth Group (range $132.83) and Cigna (range $129.30). The table and chart below present the full breakdown of mean rates and percentile values for each payer.