CPT 26350: Flexor Tendon Repair or Advancement of Hand/Finger (Not Zone 2)
CPT code 26350 denotes surgical repair or advancement of a flexor tendon of the hand or finger performed outside of zone 2 without use of a free graft. This code matters nationally because flexor tendon injuries are common causes of hand morbidity and require timely operative management to restore function; correct coding affects clinical documentation, payer authorization, and payment across ambulatory surgery centers and hospital operating rooms. Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will learn the clinical context for using CPT code 26350, typical settings where the service is performed, and how this code fits into broader billing and surgical workflow. The publication summarizes common modifiers and payer coverage patterns, highlights documentation elements that support medical necessity, and provides benchmarking and policy context where data are available. Data not available in the input is explicitly noted where applicable. The focus is national in scope and intended for coders, surgical providers, revenue cycle staff, and policy analysts who need a concise reference for billing and administrative considerations related to flexor tendon repair outside zone 2.
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Billing Code Overview
CPT code 26350 describes surgical repair or advancement of a flexor tendon of the hand or finger performed in an area other than zone 2, without the use of a free tendon graft. This procedure typically represents operative management to restore flexor tendon function after laceration or other injury.
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Service type: Surgical tendon repair/advancement
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Typical site of service: Operative setting such as an ambulatory surgery center or hospital operating room
Clinical & Coding Specifications
Clinical Context
A typical patient is a 35-year-old manual laborer who presents after a laceration to the volar aspect of the index finger from a kitchen or work-related injury, resulting in impaired active flexion of the proximal or distal interphalangeal joint. Examination and imaging localize a flexor tendon injury outside of zone II, and the patient is scheduled for operative repair under regional block or general anesthesia. Preoperative workflow includes wound assessment, tetanus status, consent, and site marking. Intraoperative steps include irrigation, exploration of the sheath if needed, identification of tendon ends, debridement of frayed tendon tissue, and primary repair or advancement of the flexor tendon without use of a free graft. The surgeon documents tendon zone (e.g., zone I, III, IV, or V), repair technique (core suture and epitendinous suture), any nerve or vascular repairs performed concurrently, tourniquet time, and estimated blood loss. Postoperative workflow includes immobilization in a dorsal blocking splint, hand therapy referral for controlled mobilization protocols, and planned follow-up for suture removal and functional assessment. Typical site of service is an ambulatory surgery center or hospital outpatient surgical suite. Service type: surgical tendon repair (hand surgery).
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
57 | Data not available in the input. | Data not available in the input. |
22 | Increased procedural services | Use when work or time is substantially greater than typical for 26350 and documentation supports increased work. |
23 | Unusual anesthesia circumstances | Use when a procedure that normally requires local anesthesia is performed under general anesthesia due to unusual circumstances. |
50 | Bilateral procedure | Use when identical tendon repairs are performed on both hands; some payors require a bilateral modifier for correct payment. |
51 | Multiple procedures | Use when 26350 is performed with unrelated additional procedures on the same day to indicate multiple-procedure payment rules. |
52 | Reduced services | Use when the service is partially reduced or not completed as documented (e.g., incomplete repair). |
53 | Discontinued procedure | Use when the procedure is started but terminated due to extenuating circumstances. |
59 | Distinct procedural service | Use to indicate a separate, distinct procedure or service from other procedures performed on the same day when not anatomically bundled. |
62 | Two surgeons | Use when two surgeons work together as primary surgeons performing distinct portions of the repair. |
79 | Unrelated procedure by same physician during post-op period | Use when an unrelated procedure is done during the global period for a prior procedure. |
80 | Assistant surgeon | Use when an assistant surgeon provides assistance during the procedure (when allowed by payor). |
81 | Minimum assistant surgeon | Use when minimal assistant services are documented. |
AS | Ambulatory surgery center facility | Use to indicate the service was performed in an ambulatory surgery center. |
LT | Left side | Use to identify the left-hand procedure when laterality is required by payor. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207X00000X | Orthopedic Surgery | Orthopedic surgeons commonly perform flexor tendon repairs of the hand. |
207P00000X | Plastic Surgery | Hand and microsurgeons in plastic surgery perform tendon repairs and complex reconstructions. |
2080P0226X | Hand Surgery | Fellowship-trained hand surgeons (orthopedic or plastic) frequently perform 26350. |
2086S0122X | General Surgery | General surgeons with hand surgery experience may perform these repairs in some settings. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
S66.211A | Laceration of flexor tendon of right index finger at forearm level, initial encounter | Flexor tendon laceration outside zone II requiring primary repair or advancement. |
S66.212A | Laceration of flexor tendon of left index finger at forearm level, initial encounter | Left-sided equivalent for planning 26350 when injury is outside zone II. |
S66.291A | Laceration of other flexor tendon of right finger(s), initial encounter | Captures other finger flexor tendon lacerations outside zone II. |
S66.292A | Laceration of other flexor tendon of left finger(s), initial encounter | Left-sided equivalent for other finger tendon lacerations. |
S66.201A | Laceration of flexor tendon of right middle finger at forearm level, initial encounter | Middle finger flexor tendon injuries outside zone II that may be repaired with 26350. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
26055 | Repair, primary, flexor tendon, forearm and/or wrist, single tendon; without free graft | Performed for flexor tendon injuries located proximal to the hand; may be used when injury extends into the wrist/forearm rather than the finger. |
26418 | Tenolysis (flexor or extensor) of finger(s) | Performed in a secondary procedure to release adhesions if primary repair results in limited tendon glide. |
64718 | Neuroplasty and/or transposition; peripheral nerve, single nerve in wrist or forearm | Used when associated digital nerve injury is repaired during the same operative session. |
26160 | Repair, tendon sheath, hand or finger; complicated | Used when extensive sheath repair or reconstruction accompanies tendon repair. |
20526 | Injection, therapeutic, tendon sheath (e.g., corticosteroid), single tendon | May be used postoperatively for persistent tenosynovitis in the hand after healing, though not performed at the initial tendon repair. |
99024 | Postoperative follow-up visit, global period services | Represents routine postoperative follow-up visits during the global period after 26350. |