Summary & Overview
CPT 26442: Tenolysis of Flexor Tendon, Finger to Palm
CPT code 26442 denotes tenolysis of a flexor tendon that extends from the finger into the palm to release adhesions and restore tendon gliding. This procedure is a focused hand surgery performed when conservative measures fail and loss of finger motion impairs function. It is nationally relevant because hand and upper-extremity procedures contribute to surgical service utilization, postoperative rehabilitation needs, and bundling considerations for payers and provider networks.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, typical sites of service, common modifiers used in billing, and guidance on which payer policies and coverage considerations are commonly relevant for tenolysis. The publication outlines benchmark topics such as typical utilization settings, billing and coding considerations for surgical hand procedures, and common documentation elements payers expect for medical necessity review.
This summary provides clinicians, billing staff, and policy analysts with a clear reference for CPT code 26442, what it represents clinically, and the payer landscape to consider when preparing claims or reviewing coverage policies at a national level.
Billing Code Overview
CPT code 26442 describes tenolysis of the flexor tendon of the palm and finger, a surgical procedure to release a flexor tendon from adhesions. The procedure extends from the finger into the palm and is intended to restore tendon gliding and finger motion when scar tissue limits function.
Service type: Surgical — Hand and Upper Extremity Surgery
Typical site of service: Hospital outpatient department or ambulatory surgery center (operating room or procedure suite)
Clinical & Coding Specifications
Clinical Context
A typical patient is a 45-year-old right-hand dominant manual laborer who presents with progressive loss of finger flexion and painful catching of the ring and small finger following a previous flexor tendon repair performed 6–12 months earlier. Conservative management including therapy and serial orthoses produced limited improvement. The surgeon schedules operative tenolysis of the flexor tendon from the palm into the finger to release adhesions and restore tendon glide.
Preoperative workflow includes evaluation in the hand surgery clinic, review of prior operative reports and imaging, informed consent specific to adhesion release and possible concomitant procedures (e.g., pulley reconstruction, tendon grafting), and documentation of functional deficits. On the day of service the patient undergoes regional block or general anesthesia in an ambulatory surgery center or hospital outpatient department. The procedure typically involves exploration of the flexor sheath, careful dissection to free adhesions along the tendon from the distal palm into the affected digit, hemostasis, and assessment of passive and active glide intraoperatively. Postoperative workflow includes immobilization in a protective dressing and splint, initiation of hand therapy within a few days to maintain motion, and documentation of intraoperative findings and improvement in glide for coding and billing purposes.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services |