CPT 26352: Flexor Tendon Repair/Advancement with Free Graft, Delayed Reconstruction
CPT code 26352 covers delayed surgical repair or advancement of a flexor tendon in the hand or finger outside of zone 2 using a free graft. This code captures a specialized reconstructive procedure performed when primary repair at the time of injury is not undertaken or possible, and it is important for accurately coding complex hand surgery cases that affect function and rehabilitation needs. Nationally, correct use of this code supports appropriate clinical documentation, surgical billing, and payment for reconstructive hand services.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a national-level overview of clinical context and coding purpose, payer coverage landscape, common modifiers and billing considerations, and related service-line implications. The publication outlines benchmarks for utilization and reimbursement patterns where available and flags common policy considerations payers apply to tendon reconstruction claims.
The analysis provides clinicians, coding professionals, and revenue staff with practical context for when CPT code 26352 applies, typical sites of service, and how this code fits within hand surgery service lines. Data not available in the input is noted where applicable.
Sign up for cpt 26352 policy alerts
Get alerted when payer policies referencing 26352 are released or updated.
Billing Code Overview
CPT code 26352 describes a surgical procedure in which the provider repairs or advances a flexor tendon of the hand or finger in an area other than zone 2 using a free graft. The procedure is performed as a delayed tendon reconstruction rather than at the time of the initial injury.
Service type: Surgical — tendon repair/reconstruction
Typical site of service: Operating room or ambulatory surgery center
Clinical & Coding Specifications
Clinical Context
A 42-year-old right-hand-dominant construction worker presents six weeks after a partial laceration of the flexor tendon of the ring finger sustained when a glass shard penetrated the palmar surface. Initial wound care and delayed primary repair were not performed at the time of injury due to contamination and soft-tissue loss. The patient now has persistent loss of active flexion at the proximal interphalangeal and distal interphalangeal joints and a palpable tendon defect. Conservative therapy has failed to restore function. The hand surgeon schedules an elective operative procedure to reconstruct the flexor tendon in an area outside of flexor zone II using a free tendon graft (e.g., palmaris longus or toe extensor graft) and tenolysis as needed.
Preoperative workup includes focused hand and neurovascular exam, hand radiographs to exclude bony injury, and review of prior wound care. The operative workflow includes general or regional anesthesia, exploration of the tendon sheath, debridement of scar tissue, harvest of the tendon graft, graft placement with core and epitendinous sutures, possible pulley reconstruction, and postoperative hand therapy with splinting and staged mobilization. Typical site of service is an outpatient ambulatory surgery center or hospital outpatient department. This is not a repair performed at the time of initial injury and is performed in an area other than flexor zone II.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work, time, or intensity substantially exceeds typical for tendon reconstruction (document specifics). |
26 | Professional component | Use when reporting only the physician's professional interpretation/component is billed separately from technical services. |
50 | Bilateral procedure | Use when identical tendon reconstruction is performed on the contralateral finger/hand in the same operative session. |
51 | Multiple procedures | Use when additional unrelated procedures are performed in the same session (report add-on or separate codes as appropriate). |
52 | Reduced services | Use when the procedure is partially reduced or not completed as originally planned (document reason). |
53 | Discontinued procedure | Use when the procedure is started but terminated due to extenuating circumstances or safety concerns. |
58 | Staged or related procedure by same physician during postoperative period | Use when this reconstruction is planned as a staged procedure following an earlier surgery. |
59 | Distinct procedural service | Use to indicate procedures that are separate and independent from other services on same date (supports separate reporting). |
62 | Two surgeons | Use when two surgeons work together as primary surgeons performing distinct parts of the reconstruction. |
66 | Surgical team | Use when a surgical team performs the procedure (team reporting scenario). |
73 | Discontinued outpatient procedure prior to anesthesia | Use when procedure cancelled after patient brought to OR but before anesthesia administration. |
78 | Unplanned return to the operating room for a related procedure during the postoperative period | Use when an unexpected complication requires return to OR for a related tendon procedure. |
79 | Data not available in the input. | Data not available in the input. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207X00000X | Orthopedic Surgery | Orthopedic hand surgeons commonly perform flexor tendon reconstructions and grafting. |
| 207P00000X | Plastic Surgery | Plastic and reconstructive surgeons with hand specialty perform complex tendon repairs and soft-tissue reconstruction. |
| 207RH0000X | Hand Surgery | Fellowship-trained hand surgeons (orthopedic or plastic background) focus on tendon reconstruction and rehabilitation. |
| 208000000X | General Surgery | General surgeons less commonly perform hand tendon grafts; included for completeness when available in a facility setting. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
S66.411A | Laceration of flexor muscle and tendon of right little finger at forearm level, initial encounter | Represents acute tendon laceration that may later require delayed reconstruction with a free graft when not repaired at initial injury. |
S66.412A | Laceration of flexor muscle and tendon of left little finger at forearm level, initial encounter | Same as above for the left side; relevant when later graft reconstruction is planned. |
M65.211 | Trigger finger, right ring finger | Chronic tendon pathology or scarring adjacent to the repair site may necessitate tendon reconstruction or adjunct procedures. |
M24.2 | Disorder of ligament, joint capsule and synovium, hand | Chronic post-injury soft tissue conditions that affect tendon function and may prompt grafting. |
T79.A1XA | Traumatic compartment syndrome of forearm, initial encounter | Severe soft-tissue injury with ischemic damage leading to tendon loss that may require graft reconstruction during delayed repair. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
26160 | Repair, flexor tendon, hand or finger, primary or secondary; without free graft, in zone other than zone 2 | Alternate code when tendon repair or advancement is performed without use of a free graft in non–zone II locations. |
25311 | Plasty; tendon (e.g., tendon lengthening or shortening) | Used when additional tendon lengthening/shortening procedures are required in the same surgical episode. |
13131 | Repair, complex, extensive undermining, or complex wound requiring significant reconstruction on the hand | Billed when significant soft-tissue reconstruction or flap coverage is required in conjunction with tendon grafting. |
64831 | Neuroplasty and/or transposition; digital nerve | Used when concomitant digital nerve repair or neuroplasty is performed during the same operative session. |
26440 | Tenolysis, flexor tendon, hand or finger | Performed when adhesions restrict glide and require release either at the time of grafting or in a staged procedure. |