Summary & Overview
CPT 26449: Tenolysis of Extensor Tendon, Finger to Forearm
CPT code 26449 represents a complex surgical tenolysis of the extensor tendon of the finger that extends into the forearm. Nationally, this code captures procedures aimed at releasing adhesions to restore tendon function after injury, scar formation, or failed prior repairs. Accurate use of this code affects surgical case classification, resource allocation, and claims processing for upper-extremity tendon reconstruction.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines how these payers approach coverage and coding for complex hand and forearm tendon procedures and highlights areas where coding specificity matters for reimbursement and utilization tracking.
Readers will learn the clinical context of the procedure, typical sites of service, and the service type associated with this code. The report also provides benchmarking guidance, common billing considerations, and recent policy developments relevant to surgical tendon-release procedures. Where available, the analysis notes common modifier usage and documentation priorities that payers may evaluate during claims review.
Data not available in the input for associated taxonomies, specific ICD-10 diagnoses, or related codes.
Billing Code Overview
CPT code 26449 describes a tenolysis of the extensor tendon of the finger to release adhesions. The procedure is complex, extending from the finger into the forearm, and is performed surgically to restore tendon glide and improve finger extension.
Service type: Surgical procedure — hand and forearm tendon surgery
Typical site of service: Operating room or ambulatory surgical center, with perioperative care that may involve a hospital setting depending on patient needs.
Data not available in the input for associated taxonomies or specific ICD-10 diagnoses.
Clinical & Coding Specifications
Clinical Context
A typical patient is a 45–65-year-old adult with a history of hand or forearm trauma, prior extensor tendon repair, or chronic post-surgical scarring who presents with progressive finger extension loss and limited interphalangeal motion despite conservative therapy. The patient reports stiffness, decreased finger range of motion, and difficulty performing activities of daily living such as grasping, buttoning, or lifting objects. Examination demonstrates adhesions restricting the extensor tendon glide, with possible palpable tethering and reduced active extension compared with passive motion.
The clinical workflow includes preoperative evaluation with history, focused hand and wrist physical exam, and imaging as indicated (plain radiographs to evaluate bony pathology; ultrasound or MRI if tendon integrity or deep adhesions are uncertain). Nonoperative management (physical therapy, splinting, anti-inflammatory medications) is typically attempted first. When persistent functional loss and adhesions are confirmed, the hand surgeon schedules operative tenolysis under regional or general anesthesia. Intraoperatively the surgeon releases adhesions along the extensor tendon from the finger to the forearm, assesses tendon gliding, and may perform limited synovectomy or scar excision. Postoperative care includes splinting, early supervised hand therapy, wound care, and activity modifications to maintain tendon glide and maximize functional recovery. Typical documentation includes indication, operative findings, procedure details (site, extent from finger to forearm), anesthesia type, estimated blood loss, and postoperative plan.
Coding Specifications
| Modifier | Description | When to Use |
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