Summary & Overview
CPT 26500: Tendon Pulley Reconstruction, Hand
CPT code 26500 denotes surgical reconstruction of a damaged tendon pulley in the finger, a procedure that restores the ring-like structures supporting tendon alignment and function. Nationally, this code is relevant to hand surgeons, orthopedic and plastic surgery practices, ambulatory surgery centers, and hospitals because pulley reconstruction can prevent tendon bowstringing and preserve digital motion and grip strength. Common clinical indications include pulley rupture from trauma or chronic tendon disorders that impair finger mechanics.
Key payers in the national landscape include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, typical sites of service, and the billing environment for 26500. The publication summarizes expected service types, common modifiers in use, and the typical payer mix. It also highlights benchmarking and policy considerations relevant to surgical repair codes, and explains what metrics and documentation elements commonly influence payment and claim adjudication for hand tendon reconstruction procedures. Data not available in the input is noted where specific payer policies, ICD-10 mappings, and taxonomies would normally appear.
Billing Code Overview
CPT code 26500 describes surgical repair of a damaged tendon pulley, a ring-like structure around the tendon sheath that maintains tendon position during finger movement. The procedure involves reconstructing the pulley using nearby soft tissues to restore normal tendon function and prevent bowstringing.
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Service type: Surgical reconstruction of tendon pulley (hand/finger tendon repair)
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Typical site of service: Ambulatory surgery center or hospital outpatient surgical setting; may also occur in an operating room when performed with other procedures.
Clinical & Coding Specifications
Clinical Context
A 38-year-old right-hand–dominant carpenter presents with progressive locking and painful triggering of the right index finger after a work-related blunt injury to the palmar aspect of the finger months earlier. Conservative measures including activity modification, splinting, and corticosteroid injection provided only transient relief. Physical exam demonstrates a palpable bowstringing and a localized zone of tenderness over the A2 pulley with limited flexion at the proximal interphalangeal joint. The hand surgeon schedules open reconstruction of the damaged pulley using nearby soft tissue (pulley reconstruction) to restore tendon alignment and prevent recurrent triggering and bowstringing. The procedure is performed in an ambulatory surgical center under regional block with local anesthesia and monitored anesthesia care. Postoperative workflow includes hand dressing, short period of observation, hand therapy referral for range-of-motion and strengthening, and routine follow-up visits for wound check and functional assessment. Payors involved may include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the reconstruction required substantially greater work or complexity than typical for 26500. |