Summary & Overview
CPT 25316: Tendon Release and Tendon Transfer for Hand/Wrist Reconstruction
CPT code 25316 denotes a surgical tendon release and tendon transfer performed to restore form and function in a severely deformed hand, wrist, or fingers. The procedure involves releasing the origin of flexor tendons to permit distal muscle glide and relocating a tendon from the forearm or wrist to a new insertion. Nationally, this code is relevant for reconstructive hand surgery, plastic and orthopedic surgery billing, and rehabilitation planning.
Key payers covered in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical intent of the code, the typical service setting, and common billing considerations tied to reconstructive tendon procedures. The report outlines benchmark payment context, common modifier usage (listed separately), and clinical context for documentation and coding accuracy. It also highlights areas where policy updates commonly affect coverage and prior authorization requirements for reconstructive hand procedures.
This summary provides clinicians, billers, and policy staff with the clinical framing and payer landscape needed to interpret claims and supporting documentation for CPT code 25316, alongside practical notes on expected sites of care and service scope. Data not available in the input is identified where applicable.
Billing Code Overview
CPT code 25316 describes a surgical procedure in which the provider releases the origin of the flexor tendons and transfers a tendon from one location in the forearm or wrist to another to improve appearance and function of a severely deformed hand, wrist, or fingers. This procedure is a type of tendon release and transfer for reconstruction of hand and wrist function.
Service type: Surgical — tendon release and tendon transfer of the forearm/wrist to the hand.
Typical site of service: Operating room or ambulatory surgery center, with postoperative care in an outpatient clinic or rehabilitation setting.
Clinical & Coding Specifications
Clinical Context
A 52-year-old right-hand-dominant patient presents with a severely deformed left hand and limited finger flexion following a longstanding traumatic injury with subsequent tendon scarring and contracture. Conservative management including splinting and therapy failed to restore function. The surgeon plans operative release of flexor tendon origins and a tendon transfer from a donor tendon in the forearm to a distal insertion to re-establish flexion and improve hand appearance and use. Preoperative workflow includes history and physical, informed consent, imaging as needed (plain radiographs +/- ultrasound), pre-op anesthesia evaluation, marking of operative site, intraoperative administration of regional or general anesthesia, performance of the tendon release and transfer, hemostasis and wound closure, and post-anesthesia recovery. Postoperative care includes immobilization in a dorsal blocking splint, supervised hand therapy starting within 1–2 weeks, routine wound checks, and staged range-of-motion progression to optimize tendon glide and function.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased Procedural Services | When work, time, or technical difficulty substantially exceeds typical expectations for the procedure. |
23 |