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    OpenPayerBilling CodesSurgical Procedures on the NailsCPT cpt-11719-routine-nail-trimming-fingers-toes
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    CPT 11719: Trimming of Normally Developed Fingernails or Toenails

    Medicare pays $15 and commercial payers pay $61 on average nationally for this procedure.

    CPT code 11719 describes the professional service of trimming one or more normally developed fingernails or toenails; this is a minor nail care service typically performed in an outpatient clinic or podiatry office as part of routine foot and nail care or to manage simple nail problems.

    For related coverage guidance, see recent payer policy updates: Lymphedema - Surgical Treatment - Medical Policy, Breast Reduction (Mammoplasty) Surgery, Mastectomy Treatment, Breast Reconstruction and Mastectomy Hospital Stays Mandates.

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    National Reimbursement Benchmarks

    Medicare's mean rate of $14.8 sits below BUCA's average commercial mean of $61.2, indicating a substantial gap between federal reimbursement and average commercial pricing for CPT 11719. This spread highlights that commercial contracts captured by BUCA pay on average about $46.4 higher than Medicare for the same code, reflecting typical commercial-to-Medicare differentials rather than local Medicare locality variation.

    Examining dispersion using the interquartile range (P75 minus P25) shows Blue Cross Blue Shield with a tight spread of $52.5? Correction: compute accurately: BCBS P75 $118.4 minus P25 $65.9 = $52.5. UnitedHealth Group IQR $13.5 (P75 $26.2 minus P25 $12.7), Aetna IQR $9.1 (P75 $14.1 minus P25 $5.0), Cigna IQR $12.1 (P75 $23.8 minus P25 $10.7), BUCA IQR $33.1 (P75 $76.8 minus P25 $41.7), Medicare IQR $1 (P75 $15 minus P25 $14). The narrowest dispersion is Medicare at $1 and the widest is Blue Cross Blue Shield at $52.5.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 68-year-old patient with type 2 diabetes mellitus and peripheral neuropathy presents to a podiatry clinic with thickened, discolored toenails causing discomfort when fitting shoes. The podiatrist evaluates the feet, documents the nail dystrophy consistent with onychauxis and onycholysis, and obtains consent for conservative nail care. In a single outpatient visit in a clinic treatment room, the provider performs trimming of one or more normally developed nails of the toes using sterile nail clippers and files, addressing overgrowth and reducing pressure points. The visit includes brief focused history, exam of the feet, and documentation of indications, procedure performed, and any patient instructions for follow-up. The procedure is billed with 11719 when trimming of normally developed fingernails or toenails is provided; more extensive debridement would be reported with 11720 or 11721 as clinically appropriate.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    11720Debridement of nail(s) by any method(s); 1 to 5Used when nails require debridement, thickened dystrophic nails or fungal involvement necessitating removal of nail material rather than simple trimming

    Related Modifiers

    8 rows

    ModifierDescriptionWhen to Use
    25CPT modifier 25 indicates that on the same day as another procedure or service, the same physician or other qualified health care professional provided a significant, separately identifiable…- When to apply: Use modifier 25 only on an E/M code to indicate the same provider delivered a significant, separately identifiable E/M service on the same day as another procedure or service — i.e.,…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    50Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
    51Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    73Modifier 73 indicates a facility-level outpatient hospital or ASC procedure that was discontinued after the patient was prepared and taken to the procedure/operating room but before any anesthesia…- When to use: Apply CPT modifier 73 on the FACILITY (outpatient hospital or ASC) claim when the patient has been fully prepared and physically taken into the procedure/operating room but the…
    57CPT® modifier -57 (“Decision for Surgery”) is appended to an Evaluation and Management (E/M) service when that encounter results in the initial decision to perform a major surgery (a procedure with a…- Use modifier 57 when an E/M service provided by the same provider (or same tax ID) on the day of or the day before a major surgical procedure (90‑day global period) results in the initial decision…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    213E00000X
    213ES0103X
    213EG0000X
    261QM0855X
    364S00000X
    364SP0808X
    246ZB0500X
    390200000X

    Related ICD-10-CM Codes

    23 rows

    ICD-10-CM CodeDescription
    A30.0Indeterminate leprosy
    A30.1Tuberculoid leprosy
    A30.2Borderline tuberculoid leprosy
    A30.3Borderline leprosy
    A30.4Borderline lepromatous leprosy
    A30.5Lepromatous leprosy
    A30.8Other forms of leprosy
    A30.9Leprosy, unspecified
    A52.10Symptomatic neurosyphilis, unspecified
    A52.11Tabes dorsalis

    Showing 1–10 of 23

    Related Payer Policy Updates

    Specialty: Plastic/Reconstructive Surgery1 / 2

    10 rows

    PolicyPayerEffective Date
    Lymphedema - Surgical Treatment - Medical PolicyHealth-New-England2027-02-01
    Breast Reduction (Mammoplasty) SurgeryKaiser Permanente2027-02-01
    Mastectomy Treatment, Breast Reconstruction and Mastectomy Hospital Stays MandatesBlue Cross Blue Shield - Rhode Island2027-01-01
    Lipodystrophy Syndrome - HIV Associated - Medical PolicyHealth-New-England2026-12-01
    Abdominal Panniculectomy and Excision of Excessive Skin and Subcutaneous Tissue - Medical PolicyHealth-New-England2026-12-01
    Reduction MammaplastyBlue Cross Blue Shield - North Dakota2026-11-01
    Cosmetic and Reconstructive ProceduresAmbetter Georgia2026-11-01
    Surgical Treatment of Lipedema and Lymphedemahusky_health2026-11-01
    Rhinoplasty Medical Necessity and Site of ServicePremera Bluecross2026-10-14
    Reconstructive Breast Surgery/Mastopexy, and Management of Breast ImplantsBlue Cross Blue Shield - North Dakota2026-10-01

    Related Codes

    CPT-11720-SURGICAL-NAIL-DEBRIDEMENT-1-TO-5-NAILS

    CPT 11720: Surgical Debridement of 1 to 5 Nails

    CPT-11721-SURGICAL-DEBRIDEMENT-SIX-OR-MORE-NAILS

    CPT 11721: Surgical Debridement of Six or More Nails

    CPT-11730-SINGLE-NAIL-PLATE-AVULSION

    CPT 11730: Simple Avulsion of Single Nail Plate

    CPT-11732-NAIL-PLATE-AVULSION-ADDITIONAL-NAIL

    CPT 11732: Additional Nail Plate Removal by Simple Avulsion

    CPT-11740-NAIL-HEMATOMA-EVACUATION-DRAINAGE

    CPT 11740: Evacuation of Nail Hematoma

    CPT-11750-NAIL-EXCISION-PLATE-AND-MATRIX

    CPT 11750: Excision of Nail Plate and Matrix

    CPT-11755-NAIL-UNIT-BIOPSY

    CPT 11755: Biopsy of Nail Plate, Bed, or Folds

    CPT-11760-NAIL-BED-REPAIR

    CPT 11760: Repair of Nail Bed

    CPT-11762-NAIL-BED-REPAIR-WITH-GRAFT

    CPT 11762: Nail Bed Repair with Graft

    CPT-11765-WEDGE-EXCISION-NAIL-FOLD-INGROWN-TOENAIL

    CPT 11765: Wedge Excision of Nail Fold at Lateral Margin

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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    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.

    11721Trimming or debridement of nails, any number (multiple)Used when multiple nails are trimmed or debrided in the same session and payer requires reporting under this code for multiple-digit service