CPT 64840 Posterior Tibial Nerve Repair Reimbursement | OpenPayer

Summary & Overview

CPT 64840: Posterior Tibial Nerve Repair, Suturing

CPT code 64840 denotes surgical suturing repair of the posterior tibial nerve, a principal branch of the sciatic nerve responsible for innervation of the rear portion of the lower extremity. This code is used to report direct repair of a major peripheral nerve and is clinically significant due to its implications for lower-extremity motor and sensory recovery, potential functional restoration, and downstream rehabilitation needs. Nationally, accurate coding for peripheral nerve repair affects surgical reporting, outcome tracking, and payment for complex reconstructive procedures.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a clinical and billing overview of the procedure, typical sites of service, and the context in which 64840 is used. The publication reviews benchmark considerations and relevant policy and coding guidance where available. It also summarizes clinical indications and procedural context for practitioners, coders, and administrative staff.

This summary provides a national perspective intended to inform clinical documentation, coding accuracy, and administrative workflows related to peripheral nerve repair. Data not available in the input is explicitly noted where applicable in the full publication.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare64840CPTperipheral-nerve-repairposterior-tibial-nervesurgical-procedureorthopedic-surgerynerve-repairambulatory-surgery

Billing Code Overview

CPT code 64840 describes surgical repair of the posterior tibial nerve using suturing techniques. The service pertains to direct nerve repair of a major peripheral nerve that originates from the sciatic nerve and supplies motor and sensory function to the posterior compartment of the lower extremity.

Service type: Peripheral nerve repair (surgical procedure)

Typical site of service: Operating room or ambulatory surgical center, performed by a surgeon with appropriate peripheral nerve surgery expertise. If specific facility or outpatient settings are used, those details are not provided here.

Clinical & Coding Specifications

Clinical Context

A typical patient is a 28-year-old male who sustained a deep laceration to the posteromedial aspect of the lower leg after a motorcycle crash. On exam he has loss of ankle inversion and decreased plantar sensation along the medial sole, consistent with posterior tibial nerve injury. Imaging and intraoperative exploration confirm a sharp transection of the posterior tibial nerve proximal to the tarsal tunnel. The patient is taken to the operating room under general anesthesia for microsurgical exploration and primary repair. The clinical workflow includes preoperative consent and neurovascular examination, intraoperative nerve stimulation and magnification (loupes or microscope), debridement of nerve ends, tension-free epineurial or perineurial suturing with microsutures, application of protective dressings, postoperative immobilization in a posterior splint or cast, and scheduled follow-up for wound checks and electrodiagnostic testing to monitor regeneration and sensory/motor recovery.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when the repair required substantially greater work or complexity than typical (extensive scar, multiple nerve branches, prolonged operative time).
`52`

CPT 64874: Peripheral Nerve Mobilization and Repositioning Repair

CPT-64835-MEDIAN-NERVE-BRANCH-REPAIR-THUMB-MOTOR-SENSORY

CPT 64835: Repair of Median Nerve Branch for Thumb Function

CPT-64866-FACIAL-TO-SPINAL-ACCESSORY-NERVE-TRANSFER-FACIAL-REANIMATION

CPT 64866: Facial Nerve to Spinal Accessory Nerve Transfer for Facial Reanimation

CPT-64858-SCIATIC-NERVE-REPAIR

CPT 64858: Repair of Sciatic Nerve

CPT-64862-LUMBAR-PLEXUS-REPAIR

CPT 64862: Lumbar Plexus Repair

CPT-64856-PERIPHERAL-NERVE-REPAIR-WITH-TRANSPOSITION

CPT 64856: Major Peripheral Nerve Repair with Transposition

CPT-64859-PERIPHERAL-NERVE-REPAIR-ADD-ON

CPT 64859: Repair of Additional Peripheral Nerves (Add-on)

CPT-64836-ULNAR-MOTOR-NERVE-REPAIR

CPT 64836: Ulnar Motor Nerve Repair

CPT-64834-SENSORY-NERVE-REPAIR-HAND-FOOT

CPT 64834: Sensory Nerve Repair of Hand or Foot

CPT-64861-BRACHIAL-PLEXUS-REPAIR-SURGERY

CPT 64861: Brachial Plexus Repair Surgery

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Taxonomy Code	Specialty	Notes
207L00000X	Orthopedic Surgery	Orthopedic trauma surgeons commonly perform nerve repairs associated with lower extremity injuries.
2080P0208X	Neurological Surgery	Neurosurgeons or peripheral nerve specialists perform microsurgical nerve repair and reconstruction.
2084P0800X	Plastic and Reconstructive Surgery	Plastic surgeons with microsurgery expertise perform peripheral nerve repairs and grafting.
207X00000X	General Surgery	General surgeons with peripheral nerve training may perform repairs in trauma settings.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S76.821A`	Injury of posterior tibial nerve, right lower leg, initial encounter	Direct traumatic transection or laceration of the posterior tibial nerve requiring primary repair.
`S76.822A`	Injury of posterior tibial nerve, left lower leg, initial encounter	Left-sided equivalent; used when injury is on the left and repair is performed.
`G57.52`	Painful neuropathy of tibial nerve	May represent neuropathic pain due to tibial nerve injury that leads to diagnostic evaluation and possible repair.
`G56.41`	Lesion of tibial nerve, right lower limb	Nontraumatic lesion or compressive neuropathy of the tibial nerve that may require surgical decompression or repair.
`G56.42`	Lesion of tibial nerve, left lower limb	Left-sided lesion; indicates pathology of tibial nerve which can be addressed surgically.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`64840`	Suture of posterior tibial nerve	Primary code describing microsurgical repair of the posterior tibial nerve.
`69990`	Microsurgical techniques, requiring use of an operating microscope (List separately in addition to code for primary procedure)	Often reported in addition to nerve repair when an operating microscope is used for precise epineurial/perineurial suturing.
`20526`	Injection, therapeutic, neurolytic agent, peripheral nerve; major branch (e.g., tibial nerve)	May be used pre- or postoperatively for diagnostic or therapeutic nerve blocks or pain management adjuncts.
`64718`	Neuroplasty and/or transposition; major peripheral nerve, arm or leg (eg, perineural scar release)	Performed when extensive scar tissue requires neurolysis in addition to or instead of primary nerve suture.
`64999`	Unlisted procedure, nervous system	Used for peripheral nerve procedures not specifically described by existing codes when additional atypical techniques are required.

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