CPT 64778 Reimbursement & Policy Benchmarks | OpenPayer

Summary & Overview

CPT 64778: Excision of Additional Peripheral Nerve Tumor in Finger or Toe

CPT code 64778 covers the surgical excision of an additional tumor or mass on a peripheral nerve in a different finger or toe performed during the same session as removal of an initial neuroma. The service targets painful neuromas that follow digit injury and is clinically focused on relieving neuropathic pain and restoring lost nerve function. Nationally, this code is relevant for hand and foot surgery practices, orthopedic and plastic surgeons, and facilities that manage trauma-related peripheral nerve conditions.

Key payers included in the coverage discussion are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, typical sites of service (ambulatory surgical centers and hospital operating rooms), and which common payers are relevant for coverage considerations. The publication also outlines expected benchmarking and policy topics typically associated with this type of surgical code, such as utilization patterns, bundling considerations when multiple neuroma procedures occur in a single session, and coding specificity for additional lesions.

What readers will learn: a clear definition of the procedure represented by CPT code 64778, the clinical circumstances prompting its use, the primary payer landscape nationally, and the types of policy and billing issues to watch when documenting and submitting claims for additional peripheral nerve tumor excisions in digits. Data not available in the input will be noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 64778peripheral nerve surgeryhand surgeryfoot surgeryneuroma excisionsurgical codingambulatory surgeryoperative procedure

Billing Code Overview

CPT code 64778 describes the surgical removal of an additional tumor or mass arising from a peripheral nerve in a different finger or toe during the same operative session in which an initial neuroma was removed. The procedure addresses painful neuromas that develop after digit injury or trauma and aims to relieve pain and restore nerve function lost because of the neuroma.

Service type: Surgical excision of peripheral nerve tumor (additional digit)
Typical site of service: Ambulatory surgical center or hospital operating room for hand or foot surgery

Clinical & Coding Specifications

Clinical Context

A 45-year-old right-handed construction worker presents with persistent, severe pain and numbness in the index and middle fingers of the right hand after a crush injury six months prior. Examination demonstrates point tenderness and a palpable, tender nodular mass along the digital nerve of the index finger consistent with a symptomatic neuroma, and a smaller, painful neuroma in the middle finger identified on exam and confirmed with ultrasound. Nonoperative measures (analgesics, splinting, and a steroid injection) have failed to relieve symptoms. The surgeon schedules operative neuroma excision under regional block with monitored anesthesia care.

During a single operative session the provider performs primary excision of the symptomatic neuroma in the index finger and, recognizing a second distinct neuroma in the adjacent middle finger, performs excision of that additional neuroma at the same session. The procedure aims to remove scarred nerve tissue, perform neuroma resection with nerve stump management (burying the nerve end or reconstruction as indicated), and restore function while alleviating neuropathic pain. Typical perioperative workflow includes preoperative consent, regional anesthesia (digital block or brachial plexus block), sterile preparation of the digits, excision of neuromas, hemostasis, soft tissue closure, dressing and postoperative instructions, and follow-up for wound check and hand therapy as needed.

Typical site of service: outpatient ambulatory surgery center or hospital outpatient department. Service type: peripheral nerve surgery (digital neuroma excision). Typical patient: adults with post-traumatic or postsurgical neuroma of a digital peripheral nerve causing pain, paresthesia, or functional impairment.

Coding Specifications

Modifier	Description	When to Use

CPT 64783: Additional Peripheral Nerve Neuroma Excision of Hand or Foot

CPT-64786-SCIATIC-NERVE-TUMOR-EXCISION

CPT 64786: Sciatic Nerve Tumor Excision

CPT-64788-EXCISION-SUBCUTANEOUS-TUMOR-CUTANEOUS-NERVE

CPT 64788: Excision of Subcutaneous Tumor Along Cutaneous Nerve

CPT-64774-NERVE-TUMOR-EXCISION-PERIPHERAL-NERVE

CPT 64774: Excision of Tumor from Mixed Peripheral Nerve

CPT-64792-NERVE-SHEATH-TUMOR-EXCISION-EXTENSIVE

CPT 64792: Excision of Extensive Nerve Sheath Tumor

CPT-64782-PERIPHERAL-NERVE-TUMOR-EXCISION-HAND-FOOT

CPT 64782: Excision of Peripheral Nerve Tumor, Hand or Foot

CPT-64790-PERIPHERAL-NERVE-SHEATH-TUMOR-EXCISION

CPT 64790: Excision of Peripheral Nerve Sheath Tumor

CPT-64795-NERVE-BIOPSY-NERVE-SAMPLE-EXCISION

CPT 64795: Nerve Biopsy, Excision of Nerve Sample

CPT-64787-NERVE-END-IMPLANTATION-AFTER-NEUROMA-EXCISION

CPT 64787: Nerve End Implantation After Neuroma Excision

CPT-64776-DIGITAL-NERVE-TUMOR-EXCISION-FINGER-TOE

CPT 64776: Excision of Tumor or Mass on Digital Nerve (Finger/Toe)

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Taxonomy Code	Specialty	Notes
`206E00000X`	Plastic and Reconstructive Surgery	Commonly performs digital neuroma excision and nerve reconstruction
`208800000X`	Orthopedic Surgery	Hand surgeons frequently perform peripheral nerve procedures in the digits
`2084P0205X`	General Surgery — Hand Surgery	Surgeons with hand specialty focus who manage digital nerve neuromas
`363L00000X`	Podiatry (Foot and Ankle Surgery)	Performs toe digital neuroma excision when neuromas occur in toes
`207L00000X`	Neurological Surgery	Rarely performs peripheral digital neuroma excision; more often addresses proximal nerve lesions

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S64.241A`	Injury of digital nerve of right index finger, initial encounter	Digital nerve injury commonly leads to painful neuroma formation requiring excision
`S64.242A`	Injury of digital nerve of left index finger, initial encounter	Same relevance for left-sided digital neuroma pathology
`G56.40`	Lesion of unspecified radial nerve	Peripheral nerve lesions can include neuromas; use when specific digital nerve not specified
`G56.3`	Lesion of ulnar nerve	Ulnar digital nerve lesions affecting finger sensation and pain may present as neuroma
`M79.2`	Neuralgia and neuritis, unspecified	Symptom code denoting neuropathic pain that may prompt neuroma excision

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`64778`	Excision of tumor, etc., of peripheral nerve, finger or toe; each additional tumor removed at same session (separate procedure)	This is the specific additional-tumor code used when a second distinct digital neuroma is excised during the same operative session after the primary neuroma removal
`64772`	Excision of tumorous or nontumorous lesion of peripheral nerve; single lesion, peripheral nerve	Often used for the primary excision of the initial neuroma when only one lesion is removed during the session
`64763`	Neuroplasty and/or transposition; median nerve at carpal tunnel (likely unrelated)	May be reported if concurrent proximal nerve decompression (e.g., carpal tunnel release) is performed in the same operative setting and is unrelated to the digital neuroma excision
`64831`	Repair of single peripheral nerve, hand or foot, without free nerve graft; 1st digital nerve	Reported when nerve repair is performed as part of neuroma management rather than simple excision and stump management
`69990`	Microsurgical techniques, requiring use of an operating microscope (list separately in addition to code for primary procedure)	Reported in addition when significant microscopic dissection or nerve repair necessitates operative microscope use

If other related codes are required for global reporting of anesthesia, facility, or monitoring services, those are reported separately per payer rules.

`LT`	Left side	When the procedure is performed on the left digit
`RT`	Right side	When the procedure is performed on the right digit
`59`	Distinct procedural service (Note: not in raw list)	Data not available in the input.
`76`	Repeat procedure by same physician (Note: not in raw list)	Data not available in the input.
`22`	Increased procedural services	When work is substantially greater than typical for `64778` due to complexity or extensive dissection
`52`	Reduced services	When the procedure is partially reduced or not completed as originally planned
`53`	Discontinued procedure	When the procedure is terminated before completion for patient safety reasons
`62`	Two surgeons	When two surgeons work together as primary surgeons for a complex reconstruction involving the nerve
`63`	Procedure performed on infants less than 4 kg (Note: limited applicability)	Use when patient meets criteria for neonatal modifier and anatomy warrants coding adjustments
`76`	Repeat procedure by same physician (from provided list `76` not present)	Data not available in the input.
`78`	Unplanned return to the operating room for a related procedure during the postoperative period	When the patient returns to the OR for a complication of the original neuroma excision
`79`	Unrelated procedure or service during the postoperative period (Note: not in raw list)	Data not available in the input.
`LT`	Left side (duplicate entry prevented)	Use as above

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