How much does Medicare pay for CPT 11721?

Medicare allowed an average of $42.83 per service and paid $31.18 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $85.40, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 11721?

Removal of fingernails or toenails, 6 or more nails. It was billed 5,331,089 times to 2,227,786 Medicare beneficiaries by 12,574 providers in 2024.

Does 11721 pay differently in an office than a hospital?

Yes. The allowed amount averaged $43.87 in an office setting and $23.05 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 11721 most?

Podiatry, with 5,192,771 services from 11,947 clinicians. Next are Nurse Practitioner, Physician Assistant, Family Practice.

CPT 11721

Removal of fingernails or toenails, 6 or more nails

$42.83Medicare-allowed amount per service, averaged across 5,331,089 services

Providers submitted

$85.40

Asking price, not received

Medicare allowed

$42.83

The fee schedule figure

Medicare paid

$31.18

Balance is patient coinsurance

Providers submitted an average of $85.40 for this code and Medicare allowed $42.83 — 2.0× 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 $31.18 (73%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $43.87
Hospital / facility: $23.05

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. 5,066,242 services were billed in an office setting and 264,847 in a facility.

Services: 5,331,089
Beneficiaries: 2,227,786
Providers billing it: 12,574
Total allowed: $228,330,542

What Medicare pays for CPT 11721

Across 5,331,089 services billed by 12,574 providers to 2,227,786 beneficiaries, Medicare allowed an average of $42.83 per service. That is 2.4 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 11721

Specialty	Services	Beneficiaries	Avg allowed	Providers
Podiatry	5,192,771	2,151,416	$43.04	11,947
Nurse Practitioner	108,800	60,068	$34.70	416
Physician Assistant	17,429	9,397	$33.53	83
Family Practice	3,089	1,641	$38.42	43
Internal Medicine	1,604	880	$38.39	24
Orthopedic Surgery	1,137	583	$33.73	16
General Practice	986	579	$47.22	7
Neurology	938	796	$45.38	1
Emergency Medicine	790	461	$40.25	4
Certified Clinical Nurse Specialist	680	380	$32.69	5
Cardiac Surgery	509	159	$22.52	1
General Surgery	502	327	$42.11	4
Geriatric Medicine	367	167	$42.14	4
Pain Management	305	128	$41.78	1
Infectious Disease	244	97	$41.37	1

11721 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	561,135	$46.23	$31.61	1,193
New York	552,221	$46.59	$31.85	1,242
Pennsylvania	461,395	$42.19	$31.10	817
Florida	451,965	$42.41	$31.73	963
New Jersey	343,111	$46.54	$31.89	762
Illinois	294,218	$42.54	$30.87	620
Ohio	293,337	$40.33	$30.10	668
Michigan	209,712	$42.07	$30.94	540
Texas	187,720	$41.46	$31.67	647
Massachusetts	155,282	$45.32	$31.03	294
Maryland	113,050	$45.09	$31.67	274
Missouri	111,299	$38.05	$28.70	207
Georgia	106,144	$41.09	$30.73	312
Arizona	104,890	$42.36	$31.85	310
Virginia	96,939	$42.24	$30.87	255
Iowa	94,985	$38.95	$28.89	152
Indiana	89,594	$40.09	$31.06	240
South Carolina	86,294	$40.84	$31.20	168
North Carolina	78,870	$40.59	$31.18	254
Washington	73,486	$43.68	$30.32	205
Wisconsin	70,622	$39.46	$28.92	207
Tennessee	69,373	$38.86	$30.76	218
Kentucky	68,216	$38.58	$30.14	161
Minnesota	57,415	$41.07	$29.04	131
Kansas	55,130	$37.53	$29.03	79
Connecticut	44,512	$45.66	$31.52	147
Utah	42,998	$41.44	$30.69	131
Oregon	36,614	$43.33	$30.74	118
Alabama	36,060	$39.31	$31.50	95
Oklahoma	35,888	$38.40	$31.56	94
Louisiana	33,731	$35.15	$28.01	122
Nebraska	31,686	$37.54	$29.21	71
Colorado	29,295	$42.17	$29.86	139
Delaware	28,329	$42.88	$31.53	51
Nevada	24,696	$41.81	$31.75	77
West Virginia	23,380	$36.46	$28.00	63
Maine	18,722	$41.06	$28.97	45
Montana	18,472	$40.54	$28.62	46
Rhode Island	17,745	$43.50	$31.06	56
New Mexico	17,543	$41.88	$31.58	62
Idaho	16,647	$39.01	$30.22	51
New Hampshire	16,247	$40.77	$29.05	37
Mississippi	16,053	$36.58	$30.02	44
Arkansas	15,381	$38.44	$31.43	49
Wyoming	7,184	$44.53	$29.42	9
South Dakota	7,020	$35.27	$25.22	25
North Dakota	6,264	$33.39	$24.25	28
Vermont	5,327	$40.83	$28.24	14
Hawaii	5,236	$43.75	$30.68	23
District of Columbia	4,810	$47.96	$32.29	20
Alaska	2,280	$41.83	$25.54	18
XX	1,282	$42.79	$34.15	1
Puerto Rico	985	$43.00	$32.13	15
U.S. Virgin Islands	192	$43.98	$30.55	1
Guam	107	$32.78	$24.28	3

Related codes

11720Removal of fingernails or toenails$31.70
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.