Surgical Treatment of Nails
L34887
Surgical nail procedures (avulsion, nail/matrix excision, wedge excision) are covered for symptomatic conditions such as ingrown nails, subungual abscess/hematoma, nail tumors, traumatic nail injury, severe/recurrent onychomycosis failing conservative therapy, suspected lichen planus or psoriasis requiring biopsy, onychogryphosis/onychauxis, and dystrophies jeopardizing digit integrity. Simple debridement, trimming/clipping without anesthesia, treatment of asymptomatic nails, and certain repeat procedures (more frequent than 8 months for toenails or 4 months for fingernails, or repeat excision after permanent removal) are not covered; documentation of prior treatments, failed conservative measures, prior attempts (e.g., puncture aspiration), prior procedure dates, and provider licensure/scope is required to support medical necessity and for potential post-payment review.
"Partial or complete nail avulsion, excision of the nail and nail matrix, or wedge excision of the skin of the nail fold is covered for symptomatic onychocryptosis (ingrown fingernails or toenails)."