Removal of part or all of a single nail plate using simple avulsion technique, without destruction of the nail matrix.

Verified May 8, 2026 · 6 sources ↓

Medicare: $111.56
Total RVUs: 3.34
Global, days: 0
Region: Foot & ankle

Drawn from CMSCgsmedicare

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 6 cited references ↓

Identify the specific digit treated — Medicare requires a digit-level modifier for payment consideration.
Document whether the avulsion was partial or complete and confirm no matrix destruction occurred.
Record the clinical indication: ingrown nail, infection, trauma, hematoma, or fungal pathology with associated symptoms.
For repeat avulsions within frequency thresholds (same toenail <32 weeks, fingernail <16 weeks), document the specific new indication — e.g., opposite border involvement or new pathology on recently treated border.
Note administration of local anesthesia in the procedure note; do not bill 64450 separately if the operating provider performed the digital block.
Signed and dated office visit or operative note as required by the applicable LCD.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global KX Documentation on file LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 11730 covers partial or complete avulsion of a single nail plate — no matrixectomy. The moment matrix destruction enters the picture, you're in 11750 territory. This code has a 000-day global period, meaning post-op visits on subsequent days are separately billable. Every claim must identify the specific digit via an appropriate modifier; Medicare will not process payment without it.

For bilateral or medial-and-lateral involvement on the same nail, 11730 still covers the full procedure as a single unit of service — you don't split it by border. Additional nails on the same visit are picked up with add-on code 11732, one unit per subsequent nail, each with its own digit modifier. Bundling 11730 with 11750 or 11765 on the same digit same day is a coding error per CMS LCD L39258 guidance.

Repeat avulsions on the same digit within 32 weeks (toenail) or 16 weeks (fingernail) require KX modifier and documentation of a distinct clinical reason — opposite border ingrown nail or new pathology on the same border. The digital nerve block (64450) performed by the operating provider for anesthesia is bundled into 11730 and not separately reportable per NCCI.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	1.02
Practice expense RVU	2.24
Malpractice RVU	0.08
Total RVU	3.34
Medicare national rate	$111.56
Global period	0 days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

Setting	Medicare rate (national)
Office (PFS non-facility) Procedure performed in physician's office	$111.56
HOPD (APC 5051) Hospital outpatient department	$204.98

Common denial reasons

The recurring reasons claims for CPT 11730 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Missing digit modifier — CMS requires a specific digit identifier; claims without it are not considered for payment.
11730 billed with 11750 or 11765 on the same digit same day — this is incorrect coding per LCD A59028.
Repeat avulsion within the frequency threshold submitted without KX modifier and supporting documentation of a new clinical indication.
64450 billed separately by the same provider performing the avulsion — NCCI bundles the digital nerve block into 11730.
Medial and lateral borders of the same nail billed as two separate units — one unit of service covers the entire nail regardless of borders involved.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01Does 11730 have a global period?

11730 carries a 000-day global. Post-op visits the day after the procedure are separately billable without a modifier — there is no bundled follow-up window beyond the day of service.

02How do you bill when both medial and lateral borders of the same nail are treated?

Bill one unit of 11730 for the nail. CMS guidance is explicit: both borders of a single nail are covered by one code. Reporting two units for the same nail is incorrect coding.

03What code covers the second and subsequent nails treated at the same visit?

Use add-on code 11732 for each additional nail, one unit per nail, each with its own digit modifier. Do not report additional units of 11730.

04When is KX modifier required on a 11730 claim?

Append KX when billing a repeat avulsion on the same toenail within 32 weeks or the same fingernail within 16 weeks of a prior avulsion. The medical record must document a distinct clinical indication, such as ingrown nail on the opposite border or new significant pathology.

05Can 11730 and 11750 be billed together on the same digit?

No. Billing 11730 (avulsion) with 11750 (excision with matrixectomy) on the same digit on the same date is incorrect coding per multiple CMS LCDs. If matrix destruction was performed, 11750 alone is the correct code.

06Is the digital nerve block billable separately when the surgeon performs it?

No. Per NCCI, CPT 64450 performed by the operating provider as anesthesia for the avulsion is bundled into 11730 and cannot be reported separately.

07What ICD-10 codes support medical necessity for 11730?

L60.0 (ingrown nail) is the most common. Other applicable codes include L60.1 (onycholysis), B35.1 (tinea unguium), S90-series trauma codes for subungual hematoma, and L03.0x codes for nail-related paronychia. Code to the documented pathology.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira AI Scribe

Mira's AI scribe captures the digit treated, whether the avulsion was partial or complete, the clinical indication, presence of local anesthesia by the operating provider, and whether any matrix work was performed. This prevents the most common denial triggers: missing digit identification, 11730/11750 bundling errors on the same digit, and incorrect separate billing of the digital nerve block.

See how Mira captures CPT 11730 documentation