February 20, 2024

APMA met with CMS again on February 6 to revisit its policy on the surgical treatment of nails that establishes use parameters for CPT®11730 and 11732. This meeting is the latest in a series of meetings APMA has conducted with CMS to address this issue. The policy states:

• A medically reasonable and necessary repeat CPT 11730/11732 of the same nail within 32 weeks of a previous avulsion will be considered upon redetermination.

The policy goes on to provide examples of why a repeat procedure of the same nail may be medically necessary, and the two examples provided are “ingrown nail of the opposite border or a new significant pathology on the same border recently treated.”

APMA has both sent letters to and met with representatives from CMS, Novitas, Palmetto, and First Coast in its efforts to contest this policy, and to request that this policy be abolished. After the success with CPT 11750, detailed at www.apma.org/surgicalnail, APMA is continuing its discussion with CMS to discuss similar relief on CPT 11730. Previously, APMA had offered the possible solution of allowing the use of modifiers to indicate the medical necessity of these procedures deemed to be “repeat” by CMS, rather than the only current option of establishing medical necessity on redetermination. APMA will continue to update efforts and any resolutions or changes to members. If you have questions or concerns, contact the APMA Health Policy and Practice department at healthpolicy.hpp@apma.org.

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