CPT 26358 Flexor Tendon Repair Reimbursement | OpenPayer

Summary & Overview

CPT 26358: Flexor Tendon Repair of Finger with Free Graft

CPT code 26358 represents surgical repair of a flexor tendon in a finger using a free graft to reconstruct the injured tendon. This code applies to complex hand surgery intended to restore digit function and reduce pain after traumatic laceration or tendon loss. Nationally, procedures requiring tendon grafts carry higher clinical complexity and are subject to payer-specific coverage rules, bundling edits, and frequency controls.

Key payers referenced include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for grafted flexor tendon repairs, typical sites of service, and which payers commonly cover such procedures. The publication summarizes benchmarking elements and policy-relevant considerations such as coding specificity and procedural complexity that affect reimbursement and utilization monitoring.

This report is intended for clinicians, coding professionals, and payers seeking concise guidance on the clinical and billing significance of CPT code 26358. Data not available in the input for detailed payer policies, associated ICD-10 diagnoses, taxonomies, and related codes are noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare26358CPTHand surgeryFlexor tendon repairTendon graftSurgical procedureOperative careOrthopedicsPlastic surgery

Billing Code Overview

CPT code 26358 describes a surgical repair of an injured flexor tendon of a finger that incorporates a free graft to complete the repair. The procedure is performed to restore function and relieve pain in the affected digit following trauma or tendon injury.

Service type: Surgical tendon repair with tendon grafting

Typical site of service: Operative suite in an ambulatory surgery center or hospital operating room

Clinical & Coding Specifications

Clinical Context

A 34-year-old right-hand–dominant male presents to the emergency department after a workplace accident with a deep laceration to the volar aspect of the ring finger. Examination reveals loss of active flexion at the proximal interphalangeal joint and a visibly disrupted flexor digitorum superficialis tendon. Imaging rules out fracture. The hand surgeon evaluates the wound in the ED, documents tendon involvement and neurovascular status, and schedules operative repair with a free tendon graft due to segmental tendon loss. The operative workflow includes preoperative consent, regional block or general anesthesia, surgical exploration of the flexor sheath, debridement of scarred/contaminated tissue, harvest of an autologous tendon graft (commonly palmaris longus or toe extensor), interposition grafting and primary repair to re-establish tendon continuity, pulleys and sheath repair as indicated, layered closure, and a postoperative immobilization and hand therapy plan to restore function and prevent adhesion formation. Inpatient or outpatient postoperative follow-up includes wound checks, suture removal, and staged hand therapy with early controlled motion protocols when permitted.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the surgeon's professional service separate from facility technical charges.

CPT 26392: Removal of Synthetic Rod and Flexor Tendon Graft Replacement

CPT-26350-FLEXOR-TENDON-REPAIR-HAND-FINGER-NOT-ZONE-2

CPT 26350: Flexor Tendon Repair or Advancement of Hand/Finger (Not Zone 2)

CPT-26412-EXTENSOR-TENDON-REPAIR-FREE-GRAFT-HAND

CPT 26412: Extensor Tendon Repair with Free Graft, Hand

CPT-26485-PALMAR-TENDON-TRANSFER-TRANSPLANT

CPT 26485: Palmar Tendon Transfer or Transplant Without Free Graft

CPT-26478-FLEXOR-TENDON-LENGTHENING-HAND-FINGER

CPT 26478: Flexor Tendon Lengthening, Hand or Finger

CPT-26590-MACRODACTYLIA-REPAIR-DIGIT-REDUCTION

CPT 26590: Repair of Macrodactylia, Digit Reduction

CPT-26551-GREAT-TOE-TO-THUMB-RECONSTRUCTION

CPT 26551: Reconstruction of Thumb Using Great Toe Transfer

CPT-26474-TENDON-AFFIXATION-DISTAL-INTERPHALANGEAL-JOINT-STABILITY

CPT 26474: Tendon Fixation to Distal Interphalangeal Joint for Stability

CPT-26546-NONUNION-DEFORMITY-PHALANX-METACARPAL-GRAFT-FIXATION

CPT 26546: Repair of Nonunion Deformity of Phalanx or Metacarpal

CPT-26415-HAND-FINGER-TENDON-ROD-IMPLANTATION-TEMPORARY-SUPPORT

CPT 26415: Temporary Rod Implantation in Hand or Finger Tendon

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Taxonomy Code	Specialty	Notes
`207L00000X`	Orthopaedic Hand Surgery	Orthopaedic surgeons specializing in hand and upper extremity perform complex flexor tendon repairs and grafting.
`207W00000X`	Plastic Surgery, Hand	Plastic surgeons with hand specialization perform reconstructive tendon grafting and soft-tissue management.
`2080P0004X`	General Surgery (Hand Surgery focus)	General surgeons with specialized hand surgery training may perform these repairs in certain settings.
`2084S0112X`	Emergency Medicine	Emergency physicians perform initial assessment, irrigation, tetanus prophylaxis, and facilitate urgent operative referral.
`363L00000X`	Occupational Therapy	Occupational and hand therapists provide postoperative therapy, though this is a provider service taxonomy rather than a surgical taxonomy.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S66.211A`	Laceration of flexor tendon of right little finger at forearm level, initial encounter	Directly describes a traumatic flexor tendon injury needing repair and possible grafting.
`S66.212A`	Laceration of flexor tendon of left little finger at forearm level, initial encounter	As above for the left side; laterality impacts coding and billing.
`S66.221A`	Laceration of flexor tendon of right ring finger at forearm level, initial encounter	Common mechanism for industrial or sharp-object injuries to fingers requiring tendon graft.
`S66.222A`	Laceration of flexor tendon of left ring finger at forearm level, initial encounter	Left-sided counterpart for accurate laterality reporting.
`M66.831`	Spontaneous rupture of flexor tendon, right hand	Applicable when grafting is required for degenerative or spontaneous tendon rupture rather than trauma.
`S61.201A`	Laceration without foreign body of right hand, initial encounter	General wound code that may accompany tendon injury coding for comprehensive documentation.
`T79.A1`	Traumatic amputation of right finger(s) (Note: select appropriate)	Included when segmental loss necessitates grafting or reconstructive planning.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`26055`	Repair, flexor tendon, with free tendon graft (includes harvesting) — finger	A closely related code; may represent more limited grafting or different anatomic level and should be selected per operative details and CPT definitions.
`26160`	Tenolysis, flexor tendon, finger	Performed postoperatively if adhesions limit tendon glide following primary repair and grafting.
`11042`	Debridement; skin, subcutaneous tissue and muscle, first 20 sq cm or less	Used when extensive debridement of contaminated tissue is required prior to tendon repair (select appropriate debridement codes by depth and area).
`29827`	Arthroscopy, wrist, surgical; with therapeutic procedures (Note: wrist arthroscopy code example)	May be performed adjunctively if concomitant wrist pathology requires arthroscopic intervention (used only when clinically indicated).
`29075`	Application of long arm or long leg cast (Note: example immobilization code)	Used for postoperative immobilization of the forearm/hand when casting is required as part of postoperative care.

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