CPT 11730: Simple Avulsion of Single Nail Plate
Medicare pays $116 and commercial payers pay $158 on average nationally for this procedure.
CPT code 11730 describes simple avulsion of part or all of a single nail plate, a minor dermatologic procedure typically performed in an outpatient clinic or office-based procedure room for removal of a diseased or problematic nail using basic avulsion techniques; this service is coded to capture the single-nail plate removal procedure and is used when no nail matrix excision or more extensive surgical repair is performed.
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 $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.