Advocacy Success! Palmetto Surgical Treatment of Nails

Following comments from APMA (submitted in conjunction with AAD) and testimony from Palmetto state CAC representatives, Palmetto has modified the restrictions it proposed in its Proposed Surgical Treatment of Nails Policies. Palmetto released a final Surgical Treatment of Nails LCD and LCA that take effect January 21, 2024.  

The LCD states that a medically reasonable and necessary repeat nail excision (CPT® 11750) on the same toe is a covered indication when the documentation includes indication. The LCD also states that a medically reasonable and necessary nail avulsion (CPT® 11730) repeated on the same toe in under 32 weeks is a covered indication when the documentation includes indication. The LCA instructs providers to append Modifier KX when the repeat procedures described above are performed.

Palmetto’s Part B Jurisdiction includes AL, GA, TN, SC, VA, WV, and NC.