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CPT 11730: Simple Avulsion of Single Nail Plate
CPT code 11730 denotes the simple avulsion of part or all of a single nail plate — a common minor surgical procedure performed for nail disorders such as ingrowing nails, onycholysis, and other dystrophies. Nationally, this code matters because it captures a frequently used office-based procedural service that affects coding accuracy, billing consistency, and outpatient utilization patterns across payers. Payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare.
Readers will find a concise clinical and coding overview, comparison of how major payers handle coverage and billing for simple nail avulsion, and context on related procedural options. The publication outlines benchmarks for typical sites of service (office, clinic, outpatient procedure rooms), highlights common clinical indications tied to this service, and explains adjacent codes that represent more extensive nail procedures. This resource is intended to aid coding professionals, revenue cycle staff, and policy analysts in understanding where 11730 fits in the procedural spectrum and what to consider when classifying nail procedures for national billing and reporting purposes.
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Billing Code Overview
CPT code 11730 describes the simple avulsion (partial or complete) of a single nail plate. This procedure involves removal of part or all of a single fingernail or toenail using straightforward avulsion techniques.
Service type: Minor surgical procedure / nail avulsion
Typical site of service: Office, clinic, or outpatient procedural setting
National Reimbursement Benchmarks
Medicare’s mean rate of $115.7 sits below BUCA’s average commercial mean of $157.7, indicating that commercial arrangements captured by BUCA pay about $42 on average more than Medicare for CPT 11730. The median Medicare local rate is $114 with interquartile spread from $108 to $120, reflecting a relatively compact central tendency across 47 localities compared with the higher central tendency and wider upper range seen in BUCA (P25 $110.8, P50 $142.4, P75 $198.2).
Dispersion measured as P75 minus P25 highlights differences in variability across payers. Blue Cross Blue Shield shows a wide interquartile range of $84.8, and UnitedHealth Group and Cigna also exhibit substantial spreads of $99.6 and $91.5 respectively. Aetna’s spread is $50.8, while BUCA’s IQR is $87.4 and Medicare’s IQR is $12, making Medicare the tightest and UnitedHealth Group the widest among the listed payers.