June 26, 2023

On Thursday, APMA will meet with CMS to revisit its policy on the surgical nails treatment of establishing use parameters for CPT® 111730 and 11732. 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.” Two of the Part B Medicare Administrative Contractors (MACs)—Novitas Solutions, Inc. and First Coast Service Options, Inc.—have released policies that reflect this guidance. 

APMA has sent letters to and met with representatives from CMS, Novitas, and First Coast in its efforts to contest this policy. APMA has requested that this policy be abolished. After the success with CPT 11750 detailed at www.apma.org/surgicalnail, APMA is meeting again with CMS this week 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 members regarding its efforts and any resolutions or changes.

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