Summary & Overview
CPT 26497: Tendon Transfer for Intrinsic Hand Reconstruction
CPT code 26497 denotes a tendon transfer procedure to restore intrinsic hand function specifically for the ring and small fingers. This surgical intervention addresses loss of intrinsic muscle activity that produces metacarpophalangeal hyperextension and interphalangeal flexion, and is central to restoring pinch, grip balance, and finger alignment. Nationally, the code matters for surgical specialties (hand surgery, orthopedic and plastic surgery) and for payers managing coverage, surgical bundles, post-operative rehabilitation, and utilization of ambulatory surgical centers versus inpatient care.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context about the procedure, typical sites of service, and how this code is categorized for surgical hand reconstruction. The publication provides benchmarks and policy-relevant considerations affecting reimbursement and utilization management, along with coding nuances that influence claims submission and site-of-service decisions. Additionally, the report summarizes common modifiers and related service-line considerations when available. Data not available in the input is flagged where applicable.
Billing Code Overview
CPT code 26497 describes a surgical tendon transfer procedure performed to restore the intrinsic function of the ring and small fingers. The operation involves transferring a functioning tendon from one location to another to correct intrinsic muscle loss that leads to characteristic finger posturing: hyperextension of the metacarpophalangeal joints and flexion of the proximal and distal interphalangeal joints.
Service Type: Tendon transfer for intrinsic muscle reconstruction of the hand
Typical Site of Service: Operating room or ambulatory surgical center (hand surgery setting)
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 45-year-old right-hand dominant patient presents to a hand surgery clinic with progressive ulnar-sided intrinsic muscle weakness of the dominant hand after a peripheral nerve injury sustained in a forearm laceration 6 months prior. The patient demonstrates hyperextension at the metacarpophalangeal joints and flexion at the proximal interphalangeal joints of the ring and small fingers, consistent with loss of intrinsic function. Nonoperative measures including splinting and therapy have failed to restore balanced finger posture and function. The surgeon schedules a tendon transfer procedure to restore intrinsic function of the ring and small fingers.
The clinical workflow includes preoperative evaluation with focused hand exam and imaging as needed, informed consent, operative planning (selection of donor tendon and technique), performance of the tendon transfer under regional or general anesthesia in an ambulatory surgical center or hospital operating room, immediate postoperative immobilization and analgesia, and a structured hand therapy protocol with staged mobilization and follow-up visits to monitor tendon healing and functional recovery.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
59 | Distinct Procedural Service | Use when this tendon transfer is distinct/separate from another procedure performed on the same date and by the same provider and no other modifier better describes the circumstance. |