Summary & Overview
CPT 25312: Forearm/Wrist Tendon Transfer with Graft
CPT code 25312 denotes a surgical tendon transfer in the forearm or wrist, including harvesting and application of a graft to replace a damaged or diseased tendon and restore hand motion. This procedure is clinically important for patients with tendon rupture, chronic tendon disease, or neurologic deficits that impair hand function; nationally, it is a specialized reconstructive upper-extremity surgery performed in operative settings and ambulatory surgery centers. Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find a concise overview of the clinical context for tendon transfer and grafting, expected sites of service, and which payers commonly cover the procedure. The publication summarizes typical billing and coding considerations for CPT code 25312, highlights common modifiers encountered in claim submissions, and outlines how payers and Medicare generally categorize this service within surgical and upper-extremity care lines. The report also identifies gaps where input data are missing and points readers to areas for further operational review, such as payer-specific coverage policies, preauthorization requirements, and reimbursement benchmarks. The content is intended for billing managers, surgical practice administrators, and policy analysts seeking a national perspective on coding and coverage considerations for reconstructive tendon procedures of the forearm and wrist.
Billing Code Overview
CPT code 25312 describes a tendon transfer in the forearm or wrist in which a provider transfers a tendon from one location to another to replace a damaged or diseased tendon and restore motion of the hand. The procedure includes harvesting and applying a graft as part of the transfer.
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Service type: Surgical tendon transfer and grafting
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Typical site of service: Operating room or ambulatory surgery center for upper extremity surgery
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Clinical & Coding Specifications
Clinical Context
A 54-year-old right-handed patient presents with progressive loss of finger flexion after a distal radius fracture complicated by laceration of the flexor digitorum superficialis tendon. Conservative care and primary repair failed, and persistent loss of digit motion with functional impairment is documented. The orthopedic/hand surgeon evaluates tendon gap, donor tendon availability, and hand therapy needs. In the operating room under regional or general anesthesia, the surgeon harvests a usable tendon graft or performs a tendon transfer in the forearm or wrist (for example, transfer of the extensor carpi radialis longus to replace a ruptured flexor tendon) to restore active flexion/extension of the fingers. Intraoperative steps include exposure of the donor and recipient tendons, mobilization, measurement, graft harvest if needed, tensioning, and secure suturing with appropriate pulley or sheath reconstruction. Postoperative workflow includes immobilization, analgesia management, early controlled passive and then active hand therapy, and follow-up visits to assess tendon glide and functional recovery. Typical site of service is an ambulatory surgery center or hospital operating room depending on complexity and patient comorbidities. Service type: surgical tendon transfer with graft harvest and application to restore hand motion, consistent with reconstructive orthopedic/hand surgery.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work, time, and complexity substantially exceed the typical service for (document reasons). |