Summary & Overview
CPT 26580: Repair of Cleft Hand, Reconstructive Hand Surgery
CPT code 26580 represents surgical repair of a cleft hand, a congenital hand deformity where central digits are absent and a V-shaped cleft is present. This reconstructive hand surgery code is relevant nationally for pediatric and congenital hand care, plastic and orthopedic hand surgery billing, and surgical quality measurement. CPT code 26580 captures a service that affects functional outcomes, long-term rehabilitation needs, and resource utilization in surgical specialties.
Key payers in common coverage and payment discussions include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a clinical and billing-focused overview of the procedure, typical settings where it is performed, and the payer landscape addressed in the publication. The content covers coding context, common modifiers and service line considerations, and how the procedure fits into specialty care pathways.
This publication provides benchmarks and payment context where available, summarizes policy and coverage considerations that commonly affect authorization and reimbursement for reconstructive congenital hand procedures, and outlines clinical context useful for coding, billing, and care coordination. Data not available in the input is clearly noted where applicable.
Billing Code Overview
CPT code 26580 describes the surgical repair of a cleft hand, a congenital deformity characterized by absence of one or more central digits producing a V-shaped cleft in the center of the hand. The procedure restores form and function by reconstructing digital rays, soft tissue, and web spaces to improve hand prehension and cosmesis.
Service type: Reconstructive hand surgery
Typical site of service: Inpatient or outpatient surgical setting, commonly performed in hospital operating rooms or ambulatory surgery centers depending on complexity and patient factors.
Clinical & Coding Specifications
Clinical Context
A 6-month-old infant is evaluated by a pediatric plastic surgeon for a congenital cleft hand (central deficiency resulting in a V-shaped cleft of the hand) present since birth. The child has absent or hypoplastic central digits causing functional limitation of grasp and pinch, and the family desires surgical reconstruction to improve hand contour, crease patterns, and prehensile function. Preoperative assessment includes detailed hand examination, radiographs of the hand to evaluate bone and digit elements, anesthesia evaluation, and counseling about staged reconstruction and possible need for skin flaps, tendon balancing, and web space reconstruction.
On the day of surgery the patient is admitted to an ambulatory surgery unit or pediatric operating room. General endotracheal anesthesia with regional block as indicated is administered. The surgeon performs soft tissue rearrangement and reconstruction of central rays, web deepening, and possible syndactyly release or tendon realignment to recreate functional digits and close the central cleft. Typical postoperative workflow includes recovery room monitoring, discharge instructions for wound care and splinting, scheduled follow-up for suture removal and occupational therapy for range of motion and functional training. Billing uses the congenital hand repair code 26580 for the primary reconstruction procedure performed by the operating surgeon.
Coding Specifications
| Modifier | Description | When to Use |
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