Summary & Overview
CPT 64861: Brachial Plexus Repair Surgery
CPT code 64861 denotes surgical repair of the brachial plexus, a complex peripheral nerve network supplying the shoulder, arm, and hand. This procedure is clinically significant because brachial plexus injuries can cause profound motor and sensory deficits; timely repair may affect functional recovery and long-term disability. Nationally, the code is relevant across payers that cover specialized nerve reconstruction in inpatient and outpatient surgical settings.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, typical sites of service, and the types of services captured by this code. The publication summarizes benchmark reimbursement considerations, common modifier usage, and payer coverage patterns where available. It also outlines the clinical scenarios that typically prompt use of this code and highlights policy or billing issues that commonly arise with complex peripheral nerve repairs.
The content is designed for clinicians, coding professionals, and payer policy analysts seeking a clear national-level briefing on CPT code 64861, including operational implications for surgical service lines and documentation elements that align with the code's clinical intent. Data not available in the input is identified explicitly where applicable.
Billing Code Overview
CPT code 64861 describes surgical repair of the brachial plexus, a network of nerves that transmits signals between the spinal cord and the shoulder, arm, and hand. The procedure addresses nerve disruption caused by trauma, lesions, infection, or other conditions that impair upper-extremity motor and sensory function.
Service type: Surgical repair of peripheral nerves (brachial plexus repair)
Typical site of service: Hospital operating room or specialized ambulatory surgical center, where microsurgical and peripheral nerve reconstruction procedures are performed.
Clinical & Coding Specifications
Clinical Context
A 34-year-old male motor vehicle crash victim presents with immediate right upper extremity flaccid paralysis, severe shoulder pain, and paresthesia after traction injury to the neck and shoulder. Clinical evaluation demonstrates weakness in elbow flexion and wrist extension with diminished biceps reflex. MRI of the brachial plexus shows nerve root avulsion and traumatic neuroma involving the upper trunk. After multidisciplinary evaluation, the patient is taken to the operating room for surgical repair of the brachial plexus to restore motor function and relieve neuropathic pain. The clinical workflow includes preoperative neurological and electrodiagnostic assessment, informed consent, intraoperative nerve stimulation and microscopy, possible nerve grafting or neurorrhaphy, postoperative monitoring for neurovascular status, pain control, and scheduled follow-up with occupational therapy for progressive rehabilitation and functional assessment. Documentation includes preoperative localization, indication for repair, detailed operative note describing findings and repairs, identification of laterality with modifier RT or LT as appropriate, and clear postoperative functional goals.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
RT | Right side | Use when the repair is performed on the right brachial plexus. |