Surgical Treatment of Nails
L33833
Surgical avulsion, excision of the nail and nail matrix, and wedge excision of the nail fold are covered for symptomatic ingrown nails, subungual abscess/hematoma, subungual/periungual tumors, traumatic nail injuries (including after failed puncture aspiration), severe or recurrent onychomycosis unresponsive to conservative therapy, diagnostic biopsy for suspected nail psoriasis or lichen planus, onychogryphosis/onychauxis, and nail dystrophies that jeopardize digit integrity. Non-surgical care (trimming, clipping, minor debridement without anesthesia) and surgical treatment of asymptomatic conditions are not covered; repeat complete avulsion is limited to intervals of at least 16 weeks for fingernails and 32 weeks for toenails. Documentation must support diagnosis, prior conservative treatments when applicable, provider qualifications, and compliance with LCD/CMS medical necessity and payment rules, and may be subject to post-payment audit.
"Symptomatic onychocryptosis (ingrown fingernails or toenails) is covered when surgical avulsion, matrixectomy, or wedge excision is medically necessary to relieve pain, inflammation, or infection."