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.
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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.