CPT 26145 Tenosynovectomy Reimbursement & Policy | OpenPayer

Summary & Overview

CPT 26145: Tenosynovectomy of Finger or Palm Flexor Tendon Sheath

CPT code 26145 represents surgical tenosynovectomy of the finger or palm flexor tendon sheath, performed to remove inflamed or damaged synovial tissue around flexor tendons. The code is reported per tendon, making it important for hand and orthopedic surgery billing where multiple tendons may be treated in a single operative session. Nationally, accurate reporting of 26145 affects surgical case mix, resource utilization, and claims adjudication for hand surgery procedures.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, typical sites of service, common modifiers used with surgical codes, and a summary of payer coverage considerations and billing practice implications. The publication also outlines benchmarks and coding nuances that influence reimbursement and claims processing for tenosynovectomy of flexor tendons.

This resource is intended for clinical coders, billing professionals, surgical providers, and policy analysts seeking a national-level reference on coding and billing for hand surgery procedures involving tenosynovectomy.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare26145CPThand surgerytenosynovectomyflexor tendonsurgical procedureambulatory surgeryoperative coding

Billing Code Overview

CPT code 26145 describes a surgical tenosynovectomy of the finger or palm flexor tendon sheath, in which the provider removes the synovial membrane surrounding a flexor tendon. The procedure is reported once for each tendon treated.

Service type: Surgical procedure (hand surgery)
Typical site of service: Ambulatory surgical center or hospital operating room; may also be performed in an outpatient surgical clinic with appropriate sterile operating capability.

Clinical & Coding Specifications

Clinical Context

A typical patient is a 45-year-old manual laborer who presents with persistent pain, swelling, and reduced range of motion of a finger after a partial flexor tendon injury and failed conservative care (immobilization, anti-inflammatories, and hand therapy). Examination and ultrasound demonstrate chronic tenosynovitis with thickened synovial sheath impeding tendon glide. The surgeon schedules a tenosynovectomy of the affected finger flexor tendon under regional or local anesthesia with possible tourniquet control. Intraoperative steps include incision over the tendon sheath, careful exposure of the flexor tendon, excision of inflamed synovium, irrigation, hemostasis, and layered closure. Postoperative workflow includes recovery in the ambulatory surgery unit or outpatient procedure area, short-term immobilization, wound checks, analgesia, and referral to hand therapy for graduated mobilization to prevent adhesions and optimize tendon glide. Billing applies 26145 once per tendon treated; documentation must state the number of tendons and operative details to support procedure count and medical necessity.

Coding Specifications

Modifier	Description	When to Use
`50`	Bilateral procedure	Use if identical tenosynovectomy performed on corresponding digits of both hands (rare; document bilateral).

CPT 26118: Extensive Hand/Finger Soft Tissue Tumor Excision ≥3 cm

CPT-26135-MCP-JOINT-SYNOVECTOMY-EXTENSOR-HOOD-RECONSTRUCTION

CPT 26135: MCP Joint Synovectomy with Extensor Hood Reconstruction

CPT-26235-PARTIAL-EXCISION-PROXIMAL-MIDDLE-PHALANX-FINGER

CPT 26235: Partial Excision of Proximal or Middle Phalanx of Finger

CPT-26116-HAND-FINGER-SUBFASCIAL-TUMOR-EXCISION-UNDER-1-5-CM

CPT 26116: Excision of Subfascial Hand or Finger Lesion, <1.5 cm

CPT-26115-HAND-FINGER-SUBCUTANEOUS-TUMOR-EXCISION-UNDER-1-5-CM

CPT 26115: Excision of Subcutaneous Tumor or Vascular Malformation, Hand/Finger

CPT-26140-PIP-JOINT-SYNOVECTOMY-EXTENSOR-TENDON-RECONSTRUCTION

CPT 26140: Synovectomy and Extensor Tendon Reconstruction, PIP Joint

CPT-26125-ADDITIONAL-FINGER-RELEASE-PALMAR-FASCIECTOMY

CPT 26125: Additional Finger Release During Palmar Fasciectomy

CPT-26250-RADICAL-RESECTION-METACARPAL-TUMOR

CPT 26250: Radical Resection of Metacarpal Bone Tumor

CPT-26215-FINGER-BONE-CYST-TUMOR-EXCISION

CPT 26215: Excision of Bone Cyst or Tumor, Finger

CPT-26230-PARTIAL-METACARPAL-EXCISION-HAND-SURGERY

CPT 26230: Partial Excision of Metacarpal Bone, Hand

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Taxonomy Code	Specialty	Notes
`207X00000X`	Orthopedic Hand Surgery	Orthopedic surgeons with hand specialization commonly perform tenosynovectomy.
`207XS0101X`	Plastic and Reconstructive Surgery (Hand)	Plastic surgeons with hand focus perform tendon and synovial procedures.
`208400000X`	General Surgery (Hand Surgery focus)	Some general surgeons with hand training perform these procedures in specialized centers.
`261QP0808X`	Occupational/Hand Therapist (non-physician)	Provides postoperative hand therapy but does not bill `26145`; included for care team context.
`207L00000X`	Orthopaedic Surgery	General orthopaedic surgeons may perform flexor tendon sheath procedures in hand trauma cases.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M65.3`	Trigger finger (stenosing tenosynovitis)	Common indication when the synovial sheath thickening impairs flexor tendon glide and conservative measures fail.
`M65.4`	Other synovitis and tenosynovitis	General code for tenosynovial inflammation requiring synovectomy when chronic.
`M67.0`	Synovial cyst of tendon sheath	Associated when cystic synovial proliferation contributes to symptoms; may be excised during tenosynovectomy.
`S66.341A`	Strain of flexor muscle, finger, initial encounter	Traumatic flexor tendon injuries with secondary synovitis that can necessitate tenosynovectomy.
`M79.641`	Pain in right hand	Symptom code used to support medical necessity when localized pain correlates with tenosynovitis.
`M79.642`	Pain in left hand	Symptom code used when the left hand is affected.
`T79.8XXA`	Other complications of trauma, initial encounter	Used in complex traumatic presentations where synovial pathology develops after injury.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`26055`	Tenolysis, direct; tendon sheath (e.g., finger flexor)	May be performed when adhesions limit tendon glide in addition to or instead of synovectomy; can be performed in the same operative session.
`26123`	Excision, tumor, sheath, tendon, or other soft tissue mass (e.g., ganglion)	Performed when a discrete synovial mass or ganglion is present in the tendon sheath and needs excision alongside tenosynovectomy.
`26010`	Incision and drainage, deep abscess or hematoma, tendon sheath (e.g., flexor tenosynovitis)	Performed in acute infectious tenosynovitis cases; irrigation/debridement may precede or replace elective synovectomy.
`20550`	Injection(s); single tendon sheath, with or without ultrasound guidance	Corticosteroid injection into the tendon sheath may be used preoperatively or as conservative management prior to surgical tenosynovectomy.
`26350`	Repair, flexor tendon, primary or secondary (zones I/II)	Performed when tenosynovectomy is done in the setting of tendon repair after injury; may be billed separately when tendon repair is performed.

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