Summary & Overview
CPT 26498: Tendon Transfer to Restore Intrinsic Function of All Four Fingers
CPT code 26498 represents a reconstructive tendon transfer procedure to restore intrinsic function of all four fingers, commonly performed to correct claw hand deformity. Nationally, this code captures complex hand surgery aimed at rebalancing finger flexion and extension mechanics and is relevant for orthopedic and plastic hand surgery billing and coverage decisions. Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will learn the clinical context of the procedure, typical sites of service, and which payers commonly adjudicate claims for this service. The summary provides benchmarks and policy-relevant considerations such as utilization patterns, common billing modifiers, and areas where prior authorization or documentation of functional impairment may affect coverage. The content also outlines coding nuances for accurate claim submission, potential settings where the procedure is performed (ambulatory surgery centers and hospital operating rooms), and the clinical indications that commonly accompany the use of this code. Data not available in the input for specific associated taxonomies, ICD-10 diagnoses, related codes, and payer-specific coverage rules is noted where applicable. This national overview is intended to inform billing staff, revenue cycle teams, and policy analysts about the procedural intent and typical billing environment for CPT code 26498.
Billing Code Overview
CPT code 26498 describes a surgical tendon transfer procedure performed to restore intrinsic function of all four fingers, commonly used to correct a claw hand deformity. The operation involves relocating one or more tendons to re-establish the balanced flexion and extension mechanics at the metacarpophalangeal and interphalangeal joints.
Service Type: Reconstructive tendon transfer surgery of the hand
Typical Site of Service: Inpatient or outpatient surgical setting, commonly performed in an ambulatory surgery center or a hospital operating room depending on patient complexity and anesthesia needs.
Clinical & Coding Specifications
Clinical Context
A 45-year-old right-hand-dominant patient presents with progressive clawing of all four fingers after a radial nerve injury and long-standing intrinsic muscle paralysis. The patient reports difficulty with grasp, pinching, and fine motor tasks; physical exam demonstrates metacarpophalangeal hyperextension and proximal interphalangeal flexion consistent with loss of intrinsic function (claw hand deformity). Nonoperative measures, including splinting and hand therapy, have been attempted with limited functional improvement. The surgical plan is a tendon transfer procedure to restore intrinsic function of the fingers, performed in an ambulatory surgery center or hospital outpatient setting under regional block with sedation or general anesthesia.
The clinical workflow includes preoperative evaluation and consent, surgical site marking, administration of anesthesia, harvest and transfer of donor tendon(s) (commonly extensor or flexor tendons such as extensor indicis or flexor digitorum superficialis depending on the chosen transfer), intraoperative tensioning and fixation to recreate intrinsic balance across the metacarpophalangeal joints, closure, sterile dressing, and immediate postoperative immobilization. Postoperative care includes analgesia, wound checks, supervised hand therapy beginning per surgeon protocol, and staged mobilization to retrain transferred tendons for intrinsic function.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT | Left side |