Summary & Overview
CPT 64718: Open Ulnar Nerve Decompression at Elbow
CPT code 64718 denotes an open ulnar nerve decompression at the elbow — an operative release of scar tissue or other compressive elements to relieve tension on the ulnar nerve. Nationally, this procedure is clinically significant because ulnar neuropathy at the elbow is a common cause of hand and forearm dysfunction and often requires surgical intervention after conservative care fails. Payers manage coverage and utilization for this procedure across outpatient surgical settings, focusing on indications, prior authorization, and site-of-service considerations.
Key payers included in the coverage landscape are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical intent and typical sites of service, plus guidance on common billing modifiers and coding relationships where available. The publication outlines benchmarks for utilization and reimbursement patterns, summarizes relevant policy trends affecting prior authorization and outpatient surgery authorization, and situates the procedure within clinical care pathways for ulnar neuropathy. This summary is written for a national audience and is intended to inform billing professionals, surgical practices, and payer policy analysts about the role and administrative considerations surrounding CPT code 64718.
Billing Code Overview
CPT code 64718 describes an open surgical procedure to release pressure on the ulnar nerve at the elbow by incising scar tissue or other compressive structures. The procedure targets decompression of the ulnar nerve, which supplies sensory and motor function to portions of the forearm, hand, and the little and ring fingers.
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Service type: Open peripheral nerve decompression / ulnar nerve release
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Typical site of service: Ambulatory surgery center or hospital operating room
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Clinical & Coding Specifications
Clinical Context
A 48-year-old right-hand–dominant patient presents with progressive numbness and paresthesia along the ulnar border of the hand, weakness with grip and finger abduction, and a positive Tinel sign at the elbow. Symptoms began after a fall with elbow swelling and have worsened over 6–12 months despite conservative management including activity modification, splinting, and targeted physical therapy. Physical exam demonstrates intrinsic hand weakness and decreased sensation in the small and ring fingers. Nerve conduction studies confirm slowed conduction across the cubital tunnel. The provider schedules an open ulnar nerve decompression at the elbow to release constricting scar tissue and fascial bands and perform an in situ decompression or neuroplasty as indicated.
The clinical workflow includes preoperative evaluation (history, focused neurological exam, informed consent), pre-op anesthesia assessment, intraoperative open release of the cubital tunnel with identification and protection of the ulnar nerve, possible transposition if unstable, hemostasis and layered closure, immediate postoperative neurovascular checks, and discharge with wound care instructions and early range-of-motion guidelines. Follow-up includes suture removal, activity progression, and outpatient hand therapy as needed.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT | Left side | Use when the procedure is performed on the left elbow/arm. |