How much does Medicare pay for CPT 11730?

Medicare allowed an average of $108.98 per service and paid $81.04 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $198.12, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 11730?

Simple separation of fingernail or toenail from nail bed, first nail. It was billed 160,811 times to 133,877 Medicare beneficiaries by 3,570 providers in 2024.

Does 11730 pay differently in an office than a hospital?

Yes. The allowed amount averaged $110.89 in an office setting and $50.70 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 11730 most?

Podiatry, with 157,575 services from 3,510 clinicians. Next are Nurse Practitioner, Internal Medicine, Orthopedic Surgery.

CPT 11730

Simple separation of fingernail or toenail from nail bed, first nail

$108.98Medicare-allowed amount per service, averaged across 160,811 services

Providers submitted

$198.12

Asking price, not received

Medicare allowed

$108.98

The fee schedule figure

Medicare paid

$81.04

Balance is patient coinsurance

Providers submitted an average of $198.12 for this code and Medicare allowed $108.98 — 1.8× 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 $81.04 (74%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $110.89
Hospital / facility: $50.70

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. 155,707 services were billed in an office setting and 5,104 in a facility.

Services: 160,811
Beneficiaries: 133,877
Providers billing it: 3,570
Total allowed: $17,525,183

What Medicare pays for CPT 11730

Across 160,811 services billed by 3,570 providers to 133,877 beneficiaries, Medicare allowed an average of $108.98 per service. That is 1.2 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 11730

Specialty	Services	Beneficiaries	Avg allowed	Providers
Podiatry	157,575	131,295	$109.35	3,510
Nurse Practitioner	1,804	1,672	$82.34	43
Internal Medicine	602	170	$117.97	2
Orthopedic Surgery	310	274	$71.26	2
Family Practice	249	209	$112.64	2
Physician Assistant	113	109	$82.32	4
Dermatology	49	42	$80.72	2
Geriatric Medicine	37	34	$105.63	1
General Practice	23	23	$119.39	1
Anesthesiology	20	20	$95.35	1
Certified Clinical Nurse Specialist	18	18	$87.70	1
Sports Medicine	11	11	$52.36	1

11730 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	23,378	$108.41	$75.14	365
New York	19,776	$124.37	$84.14	394
Pennsylvania	17,959	$107.33	$80.08	283
Florida	17,408	$109.29	$82.18	365
Illinois	10,952	$107.84	$80.99	173
New Jersey	10,272	$120.13	$82.76	210
Michigan	7,517	$109.76	$81.11	149
Texas	5,301	$103.65	$80.47	188
Massachusetts	4,658	$111.88	$78.06	113
Arizona	3,122	$106.42	$80.62	96
Georgia	2,934	$104.89	$79.20	67
North Carolina	2,725	$101.44	$81.48	85
Ohio	2,434	$101.50	$79.35	82
South Carolina	2,376	$101.28	$79.41	66
Virginia	2,232	$102.84	$77.02	75
Maryland	2,205	$112.20	$79.91	66
Tennessee	2,146	$96.18	$80.31	58
Indiana	1,750	$98.07	$77.56	58
Louisiana	1,657	$93.98	$75.26	28
Alabama	1,611	$86.56	$73.93	30
Nevada	1,427	$96.17	$73.97	30
Missouri	1,292	$90.92	$71.20	41
Washington	1,133	$109.75	$76.21	45
Kentucky	1,041	$95.78	$74.70	39
Kansas	1,023	$90.47	$76.05	39
Oklahoma	1,008	$85.69	$71.98	22
Connecticut	1,008	$117.65	$79.17	39
Mississippi	973	$95.27	$80.81	17
New Mexico	878	$105.66	$79.81	23
Utah	848	$102.60	$79.63	28
Nebraska	790	$94.75	$73.71	16
Wisconsin	784	$97.38	$73.99	33
Colorado	766	$108.68	$77.55	26
Arkansas	745	$93.72	$77.76	22
Delaware	650	$110.03	$80.34	21
Iowa	623	$95.13	$74.14	28
Minnesota	490	$108.73	$78.52	22
Oregon	435	$110.59	$81.14	14
Idaho	370	$97.59	$78.19	17
Rhode Island	323	$103.92	$78.26	14
Montana	323	$107.84	$82.41	14
Maine	311	$111.59	$78.35	12
West Virginia	256	$89.56	$70.38	12
North Dakota	175	$75.09	$57.41	8
New Hampshire	146	$99.31	$71.87	9
Hawaii	110	$119.99	$82.25	7
Puerto Rico	104	$108.91	$83.67	4
Vermont	84	$101.13	$71.83	4
Alaska	80	$126.50	$80.13	3
South Dakota	76	$51.01	$37.16	4
District of Columbia	52	$118.13	$79.23	3
Wyoming	37	$107.73	$70.76	2
XX	37	$112.81	$85.21	1

Related codes

11721Removal of fingernails or toenails$42.83
11720Removal of fingernails or toenails$31.70
11719Trimming of fingernails or toenails$10.40
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.