CPT 26350 Flexor Tendon Repair Reimbursement | OpenPayer

Summary & Overview

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.

AetnaBlue Cross Blue ShieldCignaUnitedHealthcareMedicare26350CPThand-surgeryflexor-tendon-repairambulatory-surgeryoperating-roomsurgical-proceduremedical-billing

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.

Service type: Surgical tendon repair/advancement
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.

CPT 26485: Palmar Tendon Transfer or Transplant Without Free Graft

CPT-26596-FINGER-CONSTRICTION-RELEASE-Z-PLASTY

CPT 26596: Z-plasty Release of Constricting Fibrous Ring of Finger

CPT-26536-INTERPHALANGEAL-JOINT-RECONSTRUCTION-REPLACEMENT

CPT 26536: Interphalangeal Joint Reconstruction or Replacement

CPT-26483-TENDON-TRANSFER-CARPOMETACARPAL-DORSAL-HAND

CPT 26483: Tendon Transfer/Transplant in Carpometacarpal/Dorsal Hand

CPT-26555-POLYDACTYLY-EXCISION-AND-RECONSTRUCTION

CPT 26555: Excision and Reconstruction for Polydactyly

CPT-26497-TENDON-TRANSFER-INTRINSIC-HAND-RECONSTRUCTION

CPT 26497: Tendon Transfer for Intrinsic Hand Reconstruction

CPT-26433-EXTENSOR-TENDON-DISTAL-INSERTION-REPAIR-OPEN

CPT 26433: Open Repair of Distal Extensor Tendon Insertion

CPT-26479-FLEXOR-TENDON-SHORTENING-HAND-FINGER-INSTABILITY

CPT 26479: Flexor Tendon Shortening, Hand or Finger

CPT-26372-SECONDARY-REPAIR-PROFUNDUS-TENDON-FREE-GRAFT-FINGER

CPT 26372: Secondary Repair of Finger Flexor Profundus Tendon with Free Graft

CPT-26450-OPEN-FLEXOR-TENOTOMY-PALM

CPT 26450: Open Tenotomy of Flexor Tendon, Palm

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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`.

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