CPT 26485 Palmar Tendon Transfer Reimbursement | OpenPayer

Summary & Overview

CPT 26485: Palmar Tendon Transfer or Transplant Without Free Graft

CPT code 26485 covers surgical tendon transfer or transplant procedures in the palmar area of the hand performed without a free graft. These procedures restore or improve tendon function and finger/thumb motion after trauma, nerve injury, or chronic tendon pathology. Nationally, codes for hand reconstruction are clinically important because they influence surgical planning, facility utilization, and postoperative rehabilitation pathways.

Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for CPT code 26485, typical sites of service, and the main payer landscape. The publication presents benchmarks and coverage patterns where available, summarizes relevant coding considerations for billing teams, and highlights policy updates or utilization trends affecting access to hand tendon transfer procedures.

This summary is intended for clinicians, coding professionals, and payers seeking a national perspective on the use and billing of palmar tendon transfer/transplant procedures. Data not available in the input will be identified within detailed sections.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare26485CPThand surgerytendon transfersurgical procedureorthopedicsambulatory surgeryoperative coding

Billing Code Overview

CPT code 26485 describes a surgical procedure in which a provider transfers or transplants a tendon in the palmar area of the hand without using a free graft. This procedure is typically performed to restore tendon function, improve finger or thumb motion, or correct tendon alignment following injury or chronic dysfunction.

Service type: Surgical tendon transfer/transplant in the palmar hand (open surgical procedure)
Typical site of service: Ambulatory surgical center or hospital operating room

Clinical & Coding Specifications

Clinical Context

A 42-year-old right-hand dominant construction worker presents with persistent loss of flexor tendon function in the palmar aspect of the hand following a zone II flexor tendon laceration sustained 8 months earlier. Conservative management and primary repair were not possible due to tendon attrition and scarring. The hand surgeon evaluates range of motion, grip strength, and diagnostic imaging, and documents failed prior repair and functional deficit. The patient is scheduled for tendon transfer/transplantation in the palmar hand under regional block or general anesthesia with intraoperative assessment and postoperative hand therapy.

Key workflow steps:

Preoperative evaluation with history, physical exam focused on digital motion, neurovascular status, and review of prior operative reports.
Preauthorization and medical necessity documentation referencing loss of function and failed prior repair.
Operative procedure: transfer or transplant of a palmar tendon without use of a free graft (26485) with intraoperative documentation of tendon selection, tensioning, and repair technique.
Immediate postoperative care in PACU, pain control, and splinting.
Postoperative course includes early supervised hand therapy, wound checks, and staged strengthening over weeks to months.
Typical payor interactions: Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, Medicare for coverage and claim adjudication.

Coding Specifications

Related Codes

CPT-26591-HAND-INTRINSIC-MUSCLE-REPAIR

CPT 26591: Repair of Intrinsic Muscles of the Hand

CPT-26556-TOE-TO-HAND-JOINT-TRANSFER-RECONSTRUCTIVE-MICROSURGERY

CPT 26556: Toe-to-Hand Joint Transfer for Digital Reconstruction

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

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

CPT-26596-FINGER-CONSTRICTION-RELEASE-Z-PLASTY

CPT 26596: Z-plasty Release of Constricting Fibrous Ring of Finger

CPT-26420-EXTENSOR-TENDON-REPAIR-FINGER-FREE-GRAFT

CPT 26420: Extensor Tendon Repair of Finger with Free Graft

CPT-26536-INTERPHALANGEAL-JOINT-RECONSTRUCTION-REPLACEMENT

CPT 26536: Interphalangeal Joint Reconstruction or Replacement

CPT-26356-FLEXOR-TENDON-REPAIR-FINGER

CPT 26356: Repair of Flexor Tendon of Finger

CPT-26561-SYNDACTYLY-RELEASE-SEPARATION-OF-JOINED-FINGERS

CPT 26561: Surgical Separation of Congenitally Joined Fingers

CPT-26580-CLEFT-HAND-REPAIR-RECONSTRUCTIVE-HAND-SURGERY

CPT 26580: Repair of Cleft Hand, Reconstructive Hand Surgery

CPT-26415-HAND-FINGER-TENDON-ROD-IMPLANTATION-TEMPORARY-SUPPORT

CPT 26415: Temporary Rod Implantation in Hand or Finger Tendon

Showing 1–10 of 84

Modifier	Description	When to Use
`LT`	Left side	When the procedure is performed on the left hand
`RT`	Right side	When the procedure is performed on the right hand
`50`	Bilateral procedure	When identical tendon transfers are performed on both hands during the same operative session
`59`	Distinct procedural service	When a separately identifiable tendon procedure is performed at a distinct anatomical site or on a different tendon than another billed service
`62`	Two surgeons	When two surgeons with distinct surgical roles perform portions of the procedure concurrently or sequentially and documentation supports shared responsibility
`78`	Unplanned return to OR	When the patient returns to the operating room for related care during the postoperative global period for a complication that requires additional surgery
`79`	(Not in provided list)	Data not available in the input.
`73`	Discontinued outpatient procedure prior to anesthesia induction	When the planned tendon transfer was discontinued before anesthesia for documented reasons
`52`	Reduced services	When the documented procedure is partially reduced or not fully performed compared with the standard service description
`22`	Increased procedural services	When documentation supports substantially greater work, time, or complexity than typical for `26485`
`24`	(Not in provided list)	Data not available in the input.
`76`	(Not in provided list)	Data not available in the input.

Taxonomy Code	Specialty	Notes
`207LH0000X`	Orthopaedic Hand Surgery	Specialists frequently perform complex tendon transfers in the hand
`207XS0101X`	Plastic Surgery, Hand Surgery	Plastic surgeons with hand expertise perform tendon reconstruction and transfers
`2084P0800X`	General Surgery (Hand surgeon)	Some general or peripheral surgeons trained in hand procedures perform transfers in specific settings
`2084N0400X`	Orthopaedic Surgery	Orthopaedic surgeons who treat upper extremity trauma often perform tendon transfer procedures

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M66.321`	Spontaneous rupture of flexor tendon of right hand	Flexor tendon rupture is a direct indication for tendon transfer when primary repair is not possible
`S66.011A`	Strain of flexor muscle, right forearm, initial encounter	Acute traumatic tendon injury that can lead to later reconstructive transfer if function fails to recover
`S66.012A`	Strain of flexor muscle, left forearm, initial encounter	Same relevance for left-sided injuries requiring transfer
`S66.141A`	Laceration of flexor tendon of right hand, initial encounter	Lacerations with failed primary repair commonly result in tendon transfer procedures
`M24.471`	Contracture, right hand	Severe contracture limiting tendon function may necessitate transfer to restore motion
`G56.01`	Carpal tunnel syndrome, right upper limb	Peripheral neuropathy can alter tendon function and sometimes coexists with tendon reconstruction cases
`M25.621`	Stiffness of right hand	Post-injury or post-surgical stiffness influencing decision for tendon transfer
`S66.111A`	Laceration of flexor tendon of left hand, initial encounter	Left-side lacerations relevant when planning contralateral or staged transfers

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`26055`	Tenolysis; wrist and forearm (separate procedure)	Performed when adhesions restrict tendon glide and may be done at the same operation or prior to transfer to improve motion
`26010`	Repair, flexor tendon, forearm and/or wrist; single tendon	May be performed in initial management when primary repair is feasible; relevant to prior attempts that failed before `26485` is indicated
`25999`	Unlisted procedure, forearm and wrist	Used when a specific variation of tendon reconstruction or complex technique not described by existing codes is performed in conjunction with `26485`
`26418`	Transfer or transplantation of tendon, forearm to hand, without free graft	Code for tendon transfer procedures involving the forearm to hand; may be used for transfers that originate in the forearm rather than palmar hand
`29515`	Application of short arm splint (forearm to hand); static	Common postoperative code for immobilization used immediately after tendon transfer
`99024`	Postoperative follow-up visits (global period)	Used by payors for unrelated postoperative visits or for billing documentation of care related to complications outside the global period