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CPT 26160: Excision of Lesion from Tendon Sheath or Joint Capsule, Hand/Finger
CPT code 26160 denotes the excision of a lesion (for example, a cyst or ganglion) from a tendon sheath or joint capsule in the hand or finger. This focused hand surgery procedure is commonly used to treat symptomatic ganglia and other small, localized cystic lesions that affect tendon function or cause pain. Nationally, accurate coding for 26160 supports appropriate clinical documentation, billing consistency, and surgical quality measurement for hand and orthopaedic surgery services.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. Readers will find a concise overview of clinical context for the procedure, typical sites of service, and associated diagnoses commonly billed with the code. The publication also situates 26160 relative to closely related excision codes for tendon and finger procedures, clarifying when clinicians and coders may consider alternate CPT entries.
This summary provides what to expect in the full analysis: national benchmarks and utilization patterns where available, payer coverage considerations, common clinical indications, and coding relationships to adjacent procedures. Data not available in the input will be noted as such in the detailed sections.
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Billing Code Overview
CPT code 26160 describes the surgical excision of a lesion, such as a cyst or ganglion, from a tendon sheath or joint capsule in the hand or finger. This procedure is a focused soft-tissue excision performed to remove symptomatic lesions that originate from tendon sheaths or joint capsules in the digits.
Service type: Surgical excision of lesion from tendon sheath or joint capsule
Typical site of service: Ambulatory surgery center or hospital outpatient department; may also be performed in an operating room for hand surgery
National Reimbursement Benchmarks
Commercial averages sit above Medicare for CPT 26160: Blue Cross Blue Shield and BUCA mean rates ($1,900 and $1,375.20, respectively) are meaningfully higher than Medicare’s mean of $682.90, while other large payers like UnitedHealth Group ($847.90), Cigna ($743.60), and Aetna ($435.20) fall between those points. This positions Medicare near the lower-middle of the national spectrum, with BUCA representing a higher commercial benchmark.
Dispersion measured by the interquartile range (P75 minus P25) highlights variability across payers: Blue Cross Blue Shield shows the widest spread at $1,794.90 (P75 $2,678.90 minus P25 $884.60), followed by UnitedHealth Group at $540.20 and Cigna at $602.60; Aetna is relatively tight with a spread of $448.80. BUCA’s IQR is $1,238.50 and Medicare’s IQR is $86.00, making Medicare the tightest and Blue Cross Blue Shield the most dispersed among the listed payers.