CPT 26952 Finger/Thumb Amputation Benchmarks | OpenPayer

Summary & Overview

CPT 26952: Finger or Thumb Amputation with Local Flap Closure

CPT code 26952 denotes surgical amputation of a finger or thumb at any joint or phalanx level with excision of nerve tissue and local advancement flap closure. The code covers both primary amputations performed immediately after acute injury or infection and secondary amputations performed after prior amputations that fail to heal. This procedure is clinically significant because it addresses traumatic or nonhealing digital injuries that can affect function, pain, and infection control.

Key payers included in the national analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, typical service settings, and common billing considerations for this surgical procedure. The publication outlines expected sites of service, the clinical scenarios that prompt primary versus secondary amputation, and the procedural components captured by the CPT code.

The report provides practical benchmarks and billing guidance for facility and professional claims, highlights relevant coding nuances tied to surgical technique and closure, and summarizes payer coverage themes. Data limitations: when specific input fields were not provided, the text notes that information is not available in the input.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare26952CPTfinger amputationthumb amputationsurgical procedurelocal advancement flaphand surgeryoperative codingamputation

Billing Code Overview

CPT code 26952 describes primary or secondary amputation of a finger or thumb at any joint or phalanx level with excision of nerve tissue and local advancement flap closure of the wound. Primary amputation is performed immediately after an acute injury or infection; secondary amputation is performed after a prior amputation that failed to heal properly.

Service type: Surgical amputation with local flap closure and nerve excision
Typical site of service: Hospital operating room or outpatient surgical center, depending on clinical acuity and patient condition

Clinical & Coding Specifications

Clinical Context

A 48-year-old patient presents to the hand surgery service after a crush injury to the dominant index finger causing nonviable distal phalangeal tissue and persistent intractable pain despite debridement and conservative management. Examination documents devitalized tissue, exposed bone, and a non-salvageable distal interphalangeal joint. The surgeon plans a primary amputation at the level of the proximal phalanx with excision of nerve tissue and closure using a local advancement flap in the operating room under regional block. The workflow includes preoperative evaluation, informed consent, anesthetic administration (local/regional or monitored anesthesia care), removal of nonviable tissue and nerve trimming to prevent neuroma, local advancement flap design and closure, sterile dressing, postoperative pain control, and discharge with wound care and follow-up for rehabilitation and prosthetic/splinting considerations if needed. Typical site of service is an ambulatory surgery center or hospital outpatient operating room. The service type is surgical procedure — partial or complete finger/thumb amputation with local flap closure (primary or secondary).

Coding Specifications

Modifier	Description	When to Use
`11`	Normal, uncomplicated service	Use when the procedure is the usual, uncomplicated service provided by the surgeon.

CPT 26951: Digital Amputation of Finger or Thumb with Nerve Removal

CPT-26910-METACARPAL-AND-DIGIT-AMPUTATION-HAND-SURGERY

CPT 26910: Metacarpal and Digit Amputation, Hand Surgery

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Taxonomy Code	Specialty	Notes
207P00000X	Orthopedic Surgery	Hand and upper extremity orthopedic surgeons commonly perform digital amputations.
208W00000X	Plastic Surgery	Reconstructive and flap closure expertise for local advancement flaps.
207X00000X	General Surgery	May perform urgent amputations in trauma settings when subspecialist not available.
207RH0000X	Hand Surgery	Fellowship-trained hand surgeons perform complex digit amputations and nerve management.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S68.031A`	Partial amputation of right index finger, initial encounter	Common acute traumatic indication for primary digit amputation and flap closure.
`S68.032A`	Partial amputation of left index finger, initial encounter	As above for the left side; laterality matters for billing and modifiers.
`S68.121A`	Avulsion of right thumb, initial encounter	Severe thumb injury that may require primary amputation with flap closure.
`T87.81`	Complications of amputation stump, not elsewhere classified	Indicates secondary amputation or revision after prior failed healing.
`L03.113`	Cellulitis of right finger	Severe infection leading to tissue loss and potential amputation.
`M20.42`	Other acquired deformity, left thumb (example for chronic deformity)	Chronic deformity or nonfunctional digit that may lead to secondary amputation.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`11055`	Drainage of finger abscess, simple; without complications	May be performed prior to or instead of amputation in infected fingertip scenarios to control infection.
`26121`	Repair, extensor tendon, primary or secondary; one or more tendons with direct repair	May be performed concurrently if tendons are reparable in same operative field.
`64772`	Excision, benign tumor or lesion of peripheral nerve — upper extremity or lower extremity; neuroplasty, including epineurectomy	Related to nerve management when more extensive nerve procedure is required beyond simple nerve trimming.
`12001`	Simple repair of superficial wounds of fingers; 2.5 cm or less	Used for minor closure of wounds or as adjunct when smaller closures are needed in same session.
`20610`	Arthrocentesis, aspiration and/or injection; major joint or bursa (e.g., elbow, hip, knee)	Occasionally used preoperatively for diagnostic or therapeutic injections in adjacent joints — included here for completeness when joint issues coexist.

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