CPT 26372 Reimbursement & Policy Benchmarks | OpenPayer

Summary & Overview

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

CPT code 26372 denotes a secondary surgical procedure to repair the flexor profundus tendon in a finger using a free graft while leaving the flexor superficialis intact. This procedure is clinically significant because tendon reconstructions performed after initial injury or failed primary repair present increased technical complexity, rehabilitation needs, and potential cost implications compared with primary repairs. Nationally, accurate coding of secondary tendon repair affects payment, quality tracking, and surgical outcome reporting across surgical and hand-specialty practices.

Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication summarizes how these payers commonly classify and reimburse complex hand surgery CPT codes, and it highlights considerations relevant to facility and professional billing, postoperative care, and rehabilitation service lines.

Readers will find: concise clinical context for CPT code 26372; typical sites of service and service type; common billing modifiers and administrative notes where data is available; and a high-level view of payer coverage patterns and documentation expectations. When specific data elements were not provided in the input, the text indicates that those items are not available. This overview is intended for clinicians, coding professionals, and policy analysts seeking a clear, national-level reference for secondary profundus tendon repair coding.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 26372hand surgeryflexor tendon repairsecondary repairsurgical procedureambulatory surgeryorthopedic surgerycoding and billing

Billing Code Overview

CPT code 26372 describes a secondary repair of the profundus tendon of a finger using a free graft, performed while preserving the superficialis tendon. Secondary repair indicates the procedure is done at least several days after the initial injury or a prior surgical repair.

Service type: Surgical repair of finger flexor tendon (secondary, with free grafting of profundus)

Typical site of service: Ambulatory surgical center or hospital operating room, depending on clinical complexity and patient needs.

Clinical & Coding Specifications

Clinical Context

A 32-year-old right-hand dominant construction worker presents three months after a zone I flexor tendon laceration of the ring finger that was initially managed with primary repair but developed adhesions and persistent loss of distal interphalangeal joint flexion. The patient reports diminished grip strength and inability to actively flex the fingertip. Examination shows intact flexor digitorum superficialis (FDS) function with absent or dysfunctional flexor digitorum profundus (FDP) excursion. Imaging and dynamic ultrasound confirm a failed primary FDP repair with tethering and tendon gap unsuitable for direct repair.

The hand surgeon schedules a secondary repair of the profundus tendon using a free tendon graft (e.g., palmaris longus or plantaris) while preserving the superficialis tendon. The procedure is performed in an ambulatory surgery center under regional block with monitored anesthesia care. Intraoperative steps include exposure of the tendon sheath, release of adhesions, measurement of the defect, harvest and preparation of the graft, distal and proximal tendon graft suturing (core and epitendinous repair), and balanced tensioning to restore DIP joint glide while keeping FDS intact. Postoperative care includes dorsal blocking orthosis, early controlled passive/active motion protocol under hand therapy supervision, wound checks, and staged strengthening once tendon healing permits.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services

CPT 26508: Thenar Muscle Release for Thumb Contracture

CPT-26480-TENDON-TRANSFER-TRANSPLANT-CARPOMETACARPAL-DORSUM-HAND

CPT 26480: Tendon Transfer or Transplant, Carpometacarpal/Dorsum of Hand

CPT-26476-EXTENSOR-TENDON-LENGTHENING-HAND-FINGER

CPT 26476: Extensor Tendon Lengthening of Hand or Finger

CPT-26554-TOE-TO-HAND-DIGIT-RECONSTRUCTION

CPT 26554: Toe-to-Hand Digit Reconstruction

CPT-26489-PALMAR-TENDON-TRANSFER-FREE-TENDON-GRAFT

CPT 26489: Palmar Tendon Transfer or Transplant with Free Tendon Graft

CPT-26416-EXTENSOR-TENDON-GRAFT-REPLACEMENT

CPT 26416: Extensor Tendon Graft Replacement, Hand/Finger

CPT-26428-CENTRAL-SLIP-REPAIR-BOUTONNIERE-DEFORMITY

CPT 26428: Central Slip Repair for Boutonniere Deformity

CPT-26485-PALMAR-TENDON-TRANSFER-TRANSPLANT

CPT 26485: Palmar Tendon Transfer or Transplant Without Free Graft

CPT-26565-METACARPAL-BONE-EXCISION-ROTATIONAL-DEFORMITY-CORRECTION

CPT 26565: Metacarpal Bone Excision for Rotational Deformity

CPT-26568-METACARPAL-PHALANX-LENGTHENING-OSTEODISTRACTION

CPT 26568: Metacarpal or Phalanx Bone Lengthening (Osteodistraction)

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Taxonomy Code	Specialty	Notes
207RH0000X	Orthopedic Hand Surgery	Primary specialty performing complex flexor tendon reconstruction and grafting.
207T00000X	Plastic Surgery-Hand	Common specialty performing reconstructive tendon repairs in the hand.
207K00000X	General Orthopedic Surgery	Orthopedic surgeons who perform hand and wrist tendon reconstructions.
208U00000X	Occupational/Hand Therapy	Not a surgical provider taxonomy but integral for postoperative rehabilitation (billing therapy services separately).
208000000X	Family Medicine (with surgical capability)	Rare but may appear in limited settings; include only if credentialed for hand procedures.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S66.321A`	Laceration of flexor tendon of right little finger at wrist and hand level, initial encounter	Flexor tendon lacerations are the typical injury leading to secondary FDP repair when primary repair fails.
`S66.322A`	Laceration of flexor tendon of left little finger at wrist and hand level, initial encounter	Same as above for the left side; laterality guides billing with `LT`/`RT` modifiers.
`M24.2`	Disorder of ligament, unspecified	Can be used when joint instability or soft tissue disorder contributes to tendon dysfunction requiring repair.
`M67.4`	Tenosynovitis, unspecified	Chronic tenosynovitis with adhesions can necessitate secondary tendon reconstruction with graft.
`T79.A1`	Traumatic arthropathy, initial encounter	Post-traumatic changes complicating tendon repair and requiring reconstructive procedures.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`26055`	Repair, flexor tendon, primary or secondary, forearm and/or wrist, each tendon	May be used for more proximal flexor tendon repairs when injury extends into the forearm/wrist region in the same patient.
`26160`	Repair, flexor tendon, each tendon, hand and/or finger, primary repair	Represents primary repair codes; useful for comparison when initial primary repair was performed earlier.
`26440`	Tendon sheath incision (tenolysis), finger or thumb	Performed when tenolysis of adhesions is required; may be performed in conjunction with or separate from grafting procedures.
`20930`	Tendon graft, single strand, hand/foot, includes obtaining graft	May be used when reporting free tendon grafting separate from repair technique; relates to graft harvest and preparation.
`29515`	Application of short arm cast (below elbow)	Common postoperative immobilization performed immediately after `26372` before orthosis and therapy.

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