Surgical Treatment of Nails

Surgical nail procedures (partial or complete avulsion, wedge excision, matrixectomy) are covered for symptomatic ingrown nails, subungual abscess/hematoma after failed aspiration, complicated nail-involving injuries, refractory fungal infections, onychogryphosis/onychauxis, dystrophies threatening digit integrity, diagnostic excision for suspected nail psoriasis/lichen planus, and subungual/periungual tumors. Non-surgical care such as trimming, clipping, simple debridement, or treatment of asymptomatic conditions is not covered. Repeat procedures may be allowed with specific documentation; guidance notes minimum intervals of ~32 weeks for toenails and ~16 weeks for fingernails although this language is ambiguous and may require case review.

"Symptomatic onychocryptosis (ingrown fingernail or toenail) that is moderate to severe and requires surgical treatment."