How much does Medicare pay for CPT 11720?

Medicare allowed an average of $31.70 per service and paid $23.22 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $59.09, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 11720?

Removal of fingernails or toenails, 1-5 nails. It was billed 1,797,806 times to 782,178 Medicare beneficiaries by 6,362 providers in 2024.

Does 11720 pay differently in an office than a hospital?

Yes. The allowed amount averaged $32.61 in an office setting and $13.94 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 11720 most?

Podiatry, with 1,760,506 services from 6,188 clinicians. Next are Nurse Practitioner, Physician Assistant, Certified Clinical Nurse Specialist.

CPT 11720

Removal of fingernails or toenails, 1-5 nails

$31.70Medicare-allowed amount per service, averaged across 1,797,806 services

Providers submitted

$59.09

Asking price, not received

Medicare allowed

$31.70

The fee schedule figure

Medicare paid

$23.22

Balance is patient coinsurance

Providers submitted an average of $59.09 for this code and Medicare allowed $31.70 — 1.9× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $23.22 (73%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $32.61
Hospital / facility: $13.94

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 1,710,141 services were billed in an office setting and 87,665 in a facility.

Services: 1,797,806
Beneficiaries: 782,178
Providers billing it: 6,362
Total allowed: $56,990,450

What Medicare pays for CPT 11720

Across 1,797,806 services billed by 6,362 providers to 782,178 beneficiaries, Medicare allowed an average of $31.70 per service. That is 2.3 services per beneficiary, so this is a code patients typically receive more than once. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 11720

Specialty	Services	Beneficiaries	Avg allowed	Providers
Podiatry	1,760,506	759,641	$31.82	6,188
Nurse Practitioner	32,426	19,838	$26.04	131
Physician Assistant	3,748	2,086	$27.14	23
Certified Clinical Nurse Specialist	398	198	$24.03	2
Family Practice	259	141	$26.02	7
Cardiac Surgery	177	61	$13.58	1
General Practice	107	82	$31.83	2
Internal Medicine	45	29	$29.99	2
Preventive Medicine	38	16	$37.10	1
Geriatric Medicine	28	28	$30.41	1
Orthopedic Surgery	23	12	$15.26	1
Emergency Medicine	18	18	$13.35	1
Unknown Supplier/Provider Specialty	18	17	$19.93	1
Dermatology	15	11	$35.21	1

11720 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
California	228,803	$32.88	$22.46	686
Pennsylvania	179,055	$30.96	$22.95	557
New York	167,371	$34.48	$23.64	648
New Jersey	144,980	$35.06	$24.03	469
Illinois	128,181	$30.48	$22.69	298
Florida	101,441	$30.85	$23.42	395
Maryland	98,758	$34.13	$23.51	226
Ohio	90,363	$30.03	$22.74	337
North Carolina	54,981	$29.21	$22.96	163
Texas	52,970	$29.97	$23.03	215
Massachusetts	52,627	$33.23	$23.21	185
Michigan	37,651	$30.94	$23.08	216
Missouri	36,980	$28.55	$21.96	126
Virginia	36,606	$31.76	$23.07	148
Wisconsin	31,313	$29.97	$22.11	86
Indiana	27,922	$29.45	$23.23	96
Arizona	26,020	$30.70	$23.54	116
Georgia	24,620	$29.82	$22.76	116
South Carolina	22,568	$29.71	$23.02	90
Connecticut	22,080	$34.31	$24.17	93
Kentucky	20,166	$28.83	$23.43	84
Tennessee	16,386	$28.92	$23.52	91
Rhode Island	15,359	$32.28	$22.95	50
Washington	14,780	$31.86	$21.92	94
Delaware	14,496	$31.43	$23.00	40
Kansas	13,819	$27.52	$22.01	38
Iowa	13,289	$28.44	$21.87	71
Alabama	11,450	$28.86	$22.94	54
West Virginia	11,051	$28.89	$21.72	40
Oregon	10,142	$31.13	$22.43	45
Colorado	9,981	$30.31	$21.14	54
Utah	9,850	$30.07	$23.12	40
Minnesota	8,596	$30.23	$22.13	51
Nevada	8,480	$30.19	$23.27	34
Nebraska	7,518	$28.49	$22.60	26
Idaho	5,775	$27.92	$20.96	29
Arkansas	5,280	$27.79	$22.90	25
Oklahoma	3,917	$26.48	$21.14	30
Louisiana	3,877	$27.13	$22.30	40
New Hampshire	3,712	$30.87	$21.95	26
Maine	3,544	$31.13	$22.52	14
District of Columbia	3,241	$36.63	$24.43	14
South Dakota	3,225	$23.41	$16.84	10
Mississippi	3,052	$28.28	$23.67	17
New Mexico	2,955	$30.27	$22.88	22
Montana	2,688	$32.29	$22.18	17
Vermont	2,471	$29.72	$20.72	10
Hawaii	1,772	$30.34	$23.13	12
Wyoming	1,201	$31.80	$21.90	4
North Dakota	285	$21.55	$15.65	9
Puerto Rico	76	$32.45	$23.93	3
Guam	46	$14.11	$10.71	1
Alaska	36	$31.00	$20.33	1

Related codes

11721Removal of fingernails or toenails$42.83
11719Trimming of fingernails or toenails$10.40
11730Simple separation of fingernail or toenail from nail bed$108.98
11750Permanent removal fingernail or toenail$140.90
11755Biopsy of fingernail or toenail$106.95
11765Removal of skin of fingernail or toenail$143.69
11732Simple separation of fingernail or toenail from nail bed$32.18
11740Removal of blood accumulation under fingernail or toenail$40.74
11760Repair of fingernail or toenail bed$122.75

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.