Summary & Overview
CPT 64876: Nerve Repair with Bone Excision to Allow Tension-Free Repair
CPT code 64876 denotes a surgical technique for peripheral nerve repair in which a segment of nearby bone is excised to permit tension-free approximation of shortened nerve ends. Nationally, this procedure matters because it addresses complex traumatic or iatrogenic nerve injuries where primary repair would otherwise be under tension, and outcomes can affect long-term function and disability. Payors commonly involved in coverage and claims for this procedure include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will learn the clinical context of CPT code 64876, including the service type (surgical peripheral nerve repair facilitated by bone excision) and typical sites of service (hospital operating room or ambulatory surgery center). The publication provides benchmarks and reimbursement context where available, policy updates that affect coverage and prior authorization, and coding considerations such as documentation elements that support medical necessity. Data not provided in the input will be noted as unavailable in specific sections. The goal is to clarify what CPT code 64876 represents, which payors commonly cover it, and the practical clinical and billing context for clinicians, coders, and administrators involved in managing care for patients with complex nerve injuries.
Billing Code Overview
CPT code 64876 describes a surgical procedure in which the provider repairs a portion of a nerve that is too short to reconnect without tension by excising part of a nearby bone to create length in the injured nerve and allow direct nerve end-to-end repair. This procedure is a form of peripheral nerve repair using bone shortening to reduce tension on the nerve repair site.
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Service type: Surgical nerve repair with bone excision to facilitate tension-free nerve coaptation
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Typical site of service: Hospital operating room or ambulatory surgery center
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult who sustained a traumatic laceration or crush injury to a peripheral nerve in the upper extremity (commonly the radial, ulnar, or median nerve) resulting in a segmental nerve defect where direct end-to-end repair would produce unacceptable tension. The patient presents with sensory loss, motor weakness, or neuropathic pain after acute injury or failed primary repair. Preoperative evaluation includes history and focused neuromuscular exam, electrodiagnostic testing (EMG/NCS) as indicated, and imaging (ultrasound or MRI neurography) to localize the nerve gap and assess surrounding bony anatomy.
In the operating room under regional or general anesthesia, the surgeon explores the injured nerve, measures the gap after debridement of nonviable nerve ends, and determines that lengthening is required. The provider performs partial bone excision (epineurectomy/foramina expansion or resection of a bony prominence such as a bone spike or segment) to allow mobilization of the nerve ends without tension and proceeds with direct neurorrhaphy. The procedure may occur in an ambulatory surgery center or hospital operating room depending on comorbidities, complexity, and anticipated postoperative resources. Postoperative workflow includes immobilization, pain control, wound care, and staged hand therapy for range-of-motion and motor re-education with scheduled follow-up for serial clinical and electrodiagnostic assessment.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier — standard submission |