Summary & Overview
CPT 64713: Open Release of Brachial Plexus Scar or Compression
CPT code 64713 denotes an open surgical release of scar tissue or other compressive elements affecting the brachial plexus. This procedure is used to relieve tension and restore function in patients with brachial plexus compression from scar formation, trauma, or postoperative changes. Nationally, the code is relevant for surgical specialties managing peripheral nerve entrapment and for payers evaluating coverage, billing consistency, and resource utilization for upper-extremity nerve surgeries.
Key payers in typical analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for when 64713 is used, typical sites of service, and the significance of documenting an open decompression versus less invasive alternatives. The publication outlines common billing considerations, modifier usage (listed elsewhere in the full document), and coding relationships that affect claim adjudication.
This summary prepares clinicians, coding professionals, and policy analysts to understand where 64713 fits within surgical nerve procedures, what to expect in payer coverage landscapes, and which benchmarks and policy factors commonly influence reimbursement and prior authorization practices. Data not available in the input for payer-specific rates, associated taxonomies, and ICD-10 pairings are noted elsewhere in the full report.
Billing Code Overview
CPT code 64713 describes an open surgical procedure to release scar tissue or other compressive structures affecting the brachial plexus, the network of peripheral nerves that extend from the neck through the shoulder and into the arm and hand. The objective of the procedure is to incise bands, scar tissue, or other sources of compression to relieve tension and restore nerve mobility.
Service Type: Open surgical decompression of the brachial plexus
Typical Site of Service: Operating room or hospital surgical suite, including inpatient or outpatient surgical settings depending on clinical need and perioperative planning.
Clinical & Coding Specifications
Clinical Context
A 45-year-old right-handed patient presents with progressive shoulder and upper extremity pain, paresthesia, and weakness after a prior clavicle fracture and surgical fixation. Physical exam demonstrates neurogenic symptoms consistent with brachial plexus compression and an electromyography study confirms focal plexopathy with entrapment near the supraclavicular scar. Nonoperative measures, including physical therapy and nerve pain medications, have failed. The surgical team schedules an open neurolysis of the brachial plexus to incise scar tissue and release compressive bands.
The clinical workflow includes preoperative evaluation with focused neurological examination and imaging (brachial plexus MRI or ultrasound as needed), informed consent discussing risks and benefits, perioperative antibiotics, regional or general anesthesia, open incision over the affected plexus, careful dissection to identify and protect nerve elements, incision and removal of scar tissue or fascial constricting bands relieving tension, hemostasis, layered closure, and postoperative neurological monitoring with outpatient follow-up and rehabilitation as indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when only the physician’s professional service is billed separately from the facility. |