CPT 64857 Peripheral Nerve Repair Reimbursement | OpenPayer

Summary & Overview

CPT 64857: Major Peripheral Nerve Repair of Arm or Leg

CPT code 64857 represents surgical suturing (neurorrhaphy) of a major peripheral nerve in the arm or leg, excluding the sciatic nerve. This code captures a specialized reconstructive nerve repair procedure that can affect functional recovery and long-term disability outcomes for patients with traumatic or iatrogenic nerve injuries. Nationally, accurate coding for major peripheral nerve repair is important for tracking utilization, surgical outcomes, and resource needs in orthopedic and plastic surgery services.

Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and service settings, commonly applied modifiers and payer considerations (where provided), and what typical claims lines for this procedure represent. The publication summarizes benchmarks and coding guidance where available and highlights policy updates relevant to surgical peripheral nerve repair billing. The content is intended to support revenue cycle, compliance, and clinical teams in understanding how CPT code 64857 is used and where to look for additional payer-specific rules or documentation requirements.

Data not available in the input for associated taxonomies, specific ICD-10 diagnoses, and detailed payer policy text.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 64857peripheral nerve repairneurorrhaphysurgical codingorthopedic surgeryambulatory surgeryreconstructive surgery

Billing Code Overview

CPT code 64857 describes suturing to repair a major peripheral nerve of the arm or leg, other than the sciatic nerve. This procedure entails direct repair (neurorrhaphy) of a major peripheral nerve in an upper or lower extremity when the sciatic nerve is not involved.

Service type: Surgical peripheral nerve repair
Typical site of service: Hospital operating room or ambulatory surgical center

Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.

Clinical & Coding Specifications

Clinical Context

A 32-year-old male presents to the emergency department after a deep laceration to the forearm from a kitchen accident. On examination he has loss of motor function of wrist and finger extension and decreased sensation over the dorsal hand consistent with a radial nerve injury. Imaging and neurovascular exam exclude major vascular compromise. The surgical team schedules operative exploration under regional or general anesthesia. Intraoperative findings reveal a transected major peripheral nerve of the arm requiring primary repair. The surgeon performs micro-suturing of the nerve ends with magnification and layered closure. Typical workflow includes preoperative consent, anesthesia evaluation, operative nerve exploration and repair, possible nerve grafting assessment, postoperative immobilization and referral to hand therapy for rehabilitation.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when only the surgeon’s professional work product is billed separately from facility technical service.
`59`	Distinct procedural service	Use when another service normally bundled is performed in a distinct anatomical site or at a separate encounter.

CPT 64864: Repair of Facial Nerve or Nerve in External Cranium

CPT-64836-ULNAR-MOTOR-NERVE-REPAIR

CPT 64836: Ulnar Motor Nerve Repair

CPT-64874-NERVE-MOBILIZATION-AND-REPOSITIONING-REPAIR

CPT 64874: Peripheral Nerve Mobilization and Repositioning Repair

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

CPT 64834: Sensory Nerve Repair of Hand or Foot

CPT-64840-POSTERIOR-TIBIAL-NERVE-REPAIR-SUTURING

CPT 64840: Posterior Tibial Nerve Repair, Suturing

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

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

CPT-64872-DELAYED-NERVE-REPAIR-SECONDARY-NERVE-RECONSTRUCTION

CPT 64872: Delayed (Secondary) Peripheral Nerve Repair

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

CPT 64835: Repair of Median Nerve Branch for Thumb Function

CPT-64837-ADD-ON-HAND-FOOT-NERVE-REPAIR-ADDITIONAL-NERVE-SUTURE-REPAIR

CPT 64837: Add-on Repair of Additional Hand or Foot Nerve with Sutures

CPT-64861-BRACHIAL-PLEXUS-REPAIR-SURGERY

CPT 64861: Brachial Plexus Repair Surgery

Showing 1–10 of 19

Taxonomy Code	Specialty	Notes
2080S0105X	Orthopaedic Surgery	Commonly performs upper extremity peripheral nerve repairs.
207RH0000X	Hand Surgery (Orthopedic hand)	Specialists in complex peripheral nerve and hand soft tissue repairs.
363L00000X	Plastic Surgery	Performs peripheral nerve repairs, particularly for microsurgical reconstruction.
2084P0800X	General Surgery	May perform peripheral nerve repairs in trauma settings.
2080P0222X	Physical Medicine & Rehabilitation	Often involved postoperatively for nonoperative management and rehabilitation planning.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S54.011A`	Laceration without foreign body of right radial nerve at forearm level, initial encounter	Direct traumatic transection of a major peripheral arm nerve commonly repaired with primary suture.
`S54.012A`	Laceration without foreign body of left radial nerve at forearm level, initial encounter	Same as above for the left side.
`S64.011A`	Laceration without foreign body of right ulnar nerve at forearm level, initial encounter	Ulnar nerve transections in the arm/forearm often require primary repair.
`S64.012A`	Laceration without foreign body of left ulnar nerve at forearm level, initial encounter	Ulnar nerve injury on left side indicating need for repair.
`S54.111A`	Laceration without foreign body of right median nerve at forearm level, initial encounter	Median nerve transection causing motor/sensory loss requiring microsurgical repair.
`S54.112A`	Laceration without foreign body of left median nerve at forearm level, initial encounter	Left-sided median nerve injury relevant for coding laterality.
`G56.40`	Lesion of unspecified radial nerve	Nontraumatic or chronic lesions that may require repair or revision surgery.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`64718`	Neuroplasty and/or transposition; major peripheral nerve, arm or leg	May be performed when nerve decompression or mobilization is necessary prior to or instead of primary repair.
`64856`	Repair of major peripheral nerve, arm or leg; without nerve graft	Related alternative code when nerve repair is accomplished without grafting techniques (note: `64857` specifies suturing major peripheral nerve other than sciatic).
`64873`	Repair of digital nerve, with or without vein or other conduit	May be performed for smaller digital nerve repairs in the same operative session for hand injuries.
`69990`	Microsurgical techniques, requiring use of microscope (list separately in addition to code for primary procedure)	Billed when operative microscope is used for nerve repair and payer allows separate billing.
`20680`	Removal of deep foreign body, soft tissue of extremity	Sometimes performed concurrently if foreign material is present within the wound prior to nerve repair.

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