Summary & Overview
CPT 64835: Repair of Median Nerve Branch for Thumb Function
CPT code 64835 represents surgical repair of a branch of the median nerve that innervates muscles responsible for thumb movement. This microsurgical procedure aims to restore sensory and/or motor function after traumatic or iatrogenic nerve injury and is an important code for hand and peripheral nerve surgeons, hospitals, and payers involved in upper-extremity trauma care. Nationally, timely and appropriate nerve repair affects functional outcomes, rehabilitation needs, and postacute resource use.
Key payers included in coverage and benchmarking discussions are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides a clinical and billing-focused view useful to clinicians, coding professionals, and policy analysts.
Readers will learn: the clinical context for using CPT code 64835, typical sites of service and care pathways, and the implications for coding and billing workflows. Where available, benchmark and coverage patterns for major national payers are summarized alongside notes on documentation elements critical to claim support. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 64835 describes surgical repair of a branch of the median nerve that supplies muscles involved in thumb movement. The procedure restores motor and/or sensory function after nerve injury or transection and focuses on reconstruction of the distal median nerve branches affecting thumb mobility.
Service type: Nerve repair / peripheral nerve surgery
Typical site of service: Hospital outpatient department or ambulatory surgery center; occasionally inpatient if clinical complexity requires admission
Clinical & Coding Specifications
Clinical Context
A 34-year-old right-hand dominant construction worker presents to the emergency department after a laceration to the palmar aspect of the wrist and thenar region from a power-tool accident. Examination reveals loss of thumb opposition, weakened abduction and flexion of the thumb, and diminished sensation over the radial side of the thumb. Tinel sign is positive proximal to the laceration. Imaging excludes fracture; bedside exploration suggests transection of a branch of the median nerve supplying the thenar musculature. The surgical team schedules an urgent operative repair under regional or general anesthesia. Intraoperative steps include exploration of the wound, identification of the injured median nerve branch (resection of devitalized segment if necessary), microsurgical epineurial or perineurial repair with magnification, and layered wound closure. Postoperative care includes immobilization in a thumb spica splint, pain control, monitoring for infection, and referral to hand therapy for early controlled mobilization and sensory/motor re-education. Documentation includes preoperative consent, operative report describing nerve repair technique, laterality, estimated blood loss, anesthesia type, and postoperative plan. Billing uses CPT 64835 for repair of the median nerve branch to the thumb, with applicable modifiers for laterality, professional component, or unusual services as clinically appropriate. Payers commonly involved in authorization and payment include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.
Coding Specifications
| Modifier | Description | When to Use |
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