Summary & Overview
CPT 26478: Flexor Tendon Lengthening, Hand or Finger
CPT code 26478 denotes surgical lengthening of a flexor tendon in the hand or finger to address muscle contracture and restore function. This procedure is significant nationwide because hand tendon procedures affect functional outcomes, postoperative rehabilitation needs, and surgical resource utilization across outpatient surgery centers and hospital operating rooms. Payers commonly involved in coverage and reimbursement for this service include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical and billing overview of the procedure, typical sites of service, and commonly applied billing modifiers. The publication outlines key benchmarks and payment considerations, highlights clinical context relevant to coding and claim submission, and summarizes policy updates where applicable. It also points to areas where data was not available in the input and should be reviewed by billing and compliance teams when preparing claims. This overview is written for a national audience and is intended to support coding accuracy, payer discussions, and operational planning for surgical hand services.
Billing Code Overview
CPT code 26478 describes a surgical procedure in which the provider lengthens a flexor tendon of a hand or finger to treat muscle contracture. This procedure is typically performed to increase range of motion and relieve functional impairment caused by a shortened or contracted flexor tendon.
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Service type: Surgical, tendon lengthening/tenolysis
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Typical site of service: Outpatient ambulatory surgery center or hospital operating room
Clinical & Coding Specifications
Clinical Context
A typical patient is a 45-year-old right-hand dominant manual laborer with progressive flexion contracture of the ring finger caused by Dupuytren contracture and limited passive extension despite conservative care. The patient reports difficulty performing tasks such as gripping tools and dressing. On exam the provider documents a palpable palmar cord and contracture at the proximal interphalangeal joint limiting extension. Imaging is not required for diagnosis. The planned intervention is an open flexor tendon lengthening of the affected finger under regional or general anesthesia to improve extension and hand function. The clinical workflow includes preoperative evaluation and consent, focused hand and neurovascular exam, pre-op anesthesia assessment, intraoperative procedure with sterile field and tourniquet as indicated, immediate postoperative wound care and splinting, hand therapy referral for rehabilitation, and follow-up visits to assess wound healing, tendon glide, range of motion, and functional recovery.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT | Left side | Use when the procedure is performed on the left hand or finger |
RT | Right side |