Summary & Overview
CPT 26055: Trigger Finger — Tendon Sheath Release
CPT code 26055 represents an open surgical release of the flexor tendon sheath for trigger finger (stenosing tenosynovitis). This minor hand surgery is commonly performed to relieve pain, locking, and restricted motion caused by a swollen tendon or nodules on the tendon. Nationally, the code matters because trigger finger interventions are frequent in outpatient orthopedic and hand surgery settings and generate routine surgical and facility billing activity.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides a concise overview of clinical indication and procedure coding, typical sites of service, common modifiers and billing considerations, and payer coverage patterns where available. Readers will find benchmarks for utilization and allowed amounts where present, summaries of payer policy themes relevant to procedural authorization and documentation, and clinical context describing the nature of the procedure and expected service lines.
The content is designed for coding professionals, revenue cycle managers, and clinical leaders seeking a compact reference on CPT code 26055, its clinical purpose, billing environment, and the payer landscape influencing reimbursement and prior authorization practices.
Billing Code Overview
CPT code 26055 describes surgical treatment for trigger finger (stenosing tenosynovitis) by incising the flexor tendon sheath to release constriction and restore finger motion. The procedure addresses a swollen tendon, nodule formation, or other causes that prevent smooth gliding of the flexor tendon and produce pain or locking of the affected finger.
Service type: Minor hand surgery — tendon sheath release (open pulley release)
Typical site of service: Ambulatory surgical center or hospital outpatient department; may also be performed in a clinic procedure room with appropriate sterile technique.
Clinical & Coding Specifications
Clinical Context
A 58-year-old right-hand-dominant woman presents to an outpatient hand surgery clinic with a 6-month history of pain, catching, and locking of the ring finger of her right hand. Symptoms began insidiously and are worse in the morning and with gripping activities. Conservative measures including splinting and a single corticosteroid injection provided partial, temporary relief. Physical exam demonstrates tenderness over the A1 pulley and palpable triggering with active flexion and extension of the digit. After shared decision-making, the patient is scheduled for a percutaneous or open A1 pulley release under local anesthetic with monitored anesthesia care.
The clinical workflow includes preoperative evaluation (history, focused hand exam, informed consent), perioperative marking and local/regional anesthesia, sterile preparation, incision and division of the tendon sheath (A1 pulley) to relieve stenosis, hemostasis, wound closure with a small dressing, brief postoperative recovery, and instructions for early digital motion and wound care. Typical site of service is an ambulatory surgery center or hospital outpatient department; the procedure may also be done in an office-based procedure room depending on local practice and payer rules. Usual providers are orthopedic or hand surgeons, plastic surgeons with hand specialty, or general surgeons with hand-training, often using CPT 26055 for the incision of the tendon sheath (trigger finger release).
Coding Specifications
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