Summary & Overview
CPT 26502: Tendon Pulley Reconstruction with Graft
CPT code 26502 represents surgical reconstruction of a damaged tendon pulley using a tendon or fascial graft. This procedure restores the ring-like pulley that maintains tendon alignment during finger movement and is an important repair for hand function following pulley rupture or degeneration. Nationally, pulley reconstruction is a specialized hand surgery performed by hand or orthopedic surgeons and is relevant for surgical utilization, coding accuracy, and coverage policy.
Key payers covered in the analysis include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will find a concise clinical description and context for CPT code 26502, typical settings where the service is provided, and the common modifiers associated with reporting the procedure. The publication also outlines benchmarking and coverage considerations, claims-processing implications, and clinical context for documentation and coding clarity.
This executive summary provides a national view of the code’s clinical purpose, typical site of service, and payer coverage landscape. Data not available in the input are noted where applicable; the focus remains on clinical description, service context, and the expected utility of the code in surgical hand care and billing workflows.
Billing Code Overview
CPT code 26502 describes surgical reconstruction of a damaged tendon pulley using a tendon or fascial graft. The pulley is a ring-like structure around the tendon sheath that helps maintain tendon position and function during finger movement. This procedure involves repairing or reconstructing the pulley to restore normal tendon biomechanics.
Service type: Surgical reconstruction of tendon pulley (hand surgery)
Typical site of service: Ambulatory surgery center or hospital operating room, commonly performed by hand or orthopedic surgeons in a surgical setting
Clinical & Coding Specifications
Clinical Context
A 34-year-old right-hand–dominant male presents with progressive triggering and pain of the ring finger after a sports-related flexor tendon injury six months prior. Conservative care including splinting, NSAIDs, and therapy provided partial relief but persistent pain, loss of smooth tendon gliding and a palpable gap at the A2 pulley are noted on exam. The surgical plan is reconstruction of the damaged flexor tendon pulley using an autologous tendon or palmaris/fascial graft under regional or general anesthesia. Typical workflow: preoperative evaluation and imaging if needed; consent and marking of operative finger; regional block or general anesthesia; exposure of the pulley, assessment of flexor tendon integrity, harvest and preparation of graft (e.g., palmaris longus or flexor digitorum superficialis slip), reconstruction of the pulley with graft fixation to restore the annular pulley ring and prevent bowstringing; irrigation and layered closure; postoperative immobilization in a dorsal blocking splint and early protected range-of-motion protocol with hand therapy. Typical site of service is an outpatient ambulatory surgical center or hospital outpatient operating room. Usual postoperative follow-up includes wound check within 7–14 days and supervised therapy over several weeks.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the procedure requires substantially greater work than usual (document justification in operative report). |