Summary & Overview
CPT 26418: Extensor Tendon Repair of Finger, No Graft
CPT code 26418 denotes repair of an extensor tendon in a finger without use of a graft, applicable to both early (primary) repairs and delayed (secondary) repairs. This surgical code is clinically important because extensor tendon injuries can impair hand function and require timely operative management to restore extension and prevent long-term disability. Nationwide, coverage and payment policies for tendon repair affect access to timely surgical care, rehabilitation planning, and post-operative functional outcomes.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical service, typical sites of care, common billing modifiers and coding context, and the payer mix referenced in national analyses. The publication outlines benchmarks and payment considerations, summarizes relevant policy updates that influence preauthorization and site-of-service determinations, and provides clinical context on distinctions between primary and secondary repair approaches.
This summary is intended for revenue cycle managers, surgical providers, and coding professionals seeking a focused briefing on CPT code 26418, its clinical role in hand surgery, and the payer landscape that commonly governs coverage and reimbursement for extensor tendon repair.
Billing Code Overview
CPT code 26418 describes surgical repair of extensor tendon of a finger without graft, performed as either a primary repair (within a few days of injury) or a secondary repair (performed at least a few days after the initial injury or after prior surgical repair). The procedure involves reapproximation and suture of the damaged extensor tendon to restore finger extension.
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Service type: Surgical tendon repair of the hand/finger
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Typical site of service: Outpatient surgical center or hospital operating room, depending on injury severity and patient condition
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult or adolescent who sustains a sharp laceration, crush injury, or sports-related trauma to the dorsal aspect of a finger resulting in discontinuity of one or more extensor tendons. The patient presents to an urgent care or emergency department for initial assessment; after history and focused hand exam demonstrating loss of active finger extension at the affected joint(s), plain radiographs are obtained to exclude avulsion fracture or joint injury. When tendon injury is suspected, the patient is referred to a hand surgeon or orthopedic/plastic surgeon with hand fellowship expertise. Primary repair with 26418 is performed when presentation occurs within a few days of injury and the tendon ends are amenable to direct repair. Secondary repair using the same code may be performed days to weeks after injury or after a failed prior repair; intraoperative findings may require tenolysis or scar excision. Typical operative workflow includes regional or general anesthesia, surgical exploration through a dorsal incision, identification of tendon ends, debridement, and direct end-to-end suture repair without grafting; postoperative care includes immobilization, hand therapy, and serial follow-up. Typical site of service is the operating room in a hospital or ambulatory surgical center; initial evaluation often occurs in the emergency department, urgent care, or clinic, with follow-up visits in the outpatient hand clinic.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT |