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CPT 11750: Excision of Nail Plate and Matrix (Partial or Complete)
CPT code 11750 represents surgical excision of part or all of a fingernail or toenail, including removal of the nail plate and matrix and the lunula when excision is complete. As a common minor surgical procedure, this code is used across dermatology, podiatry, and primary care settings and has implications for coding accuracy, coverage determinations, and outpatient procedural workflows nationwide. Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. Readers will learn the clinical scope of the procedure, typical sites of service, how this code relates to nearby CPT codes for simpler avulsion or related nail procedures, and common documentation elements needed to support medical necessity. The summary outlines payer coverage patterns and common contractual considerations without offering clinical recommendations. The piece also highlights coding distinctions that affect billing, such as when complete removal including the matrix and lunula is performed versus simpler avulsion procedures, and provides context for clinicians and billing staff to align documentation with claim submission. Data not available in the input is noted where applicable.
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Billing Code Overview
CPT code 11750 describes the surgical removal of part or all of a fingernail or toenail, including excision of the nail plate and the nail matrix and including the lunula when the excision is complete. This procedure is a definitive nail excision typically performed to treat severe nail disease, traumatic injury, or recurrent infection.
Service Type: Surgical procedure, nail excision
Typical Site of Service: Outpatient clinic, ambulatory surgery center, or physician office procedure room
National Reimbursement Benchmarks
Commercial averages sit well above Medicare for CPT 11750: Blue Cross Blue Shield and BUCA have notably higher means than Medicare’s $163.3. BUCA’s mean of $510.2 is roughly three times Medicare’s $163.3, while Blue Cross Blue Shield’s mean of $721.8 is even higher, indicating substantial premium in commercial networks versus the Medicare baseline.
Dispersion varies materially across payers. Blue Cross Blue Shield shows a wide interquartile spread (P75–P25 = $859.10 – $586.90 = $272.20), and Aetna also demonstrates notable spread (P75–P25 = $278.20 – $75.70 = $202.50), indicating loose negotiated variability. UnitedHealth Group (P75–P25 = $304.00 – $160.30 = $143.70) and Cigna (P75–P25 = $301.40 – $151.70 = $149.70) are tighter by comparison, while BUCA’s IQR (P75–P25 = $617.10 – $390.70 = $226.40) sits between those groups.