CPT 64890 Nerve Graft Reimbursement & Policy | OpenPayer

Summary & Overview

CPT 64890: Peripheral Nerve Graft for Hand or Foot

CPT code 64890 represents a targeted peripheral nerve grafting procedure in which a healthy nerve segment up to 4 cm replaces a damaged portion of a nerve in the hand or foot to restore sensory and/or motor function. Nationally, this procedure matters for trauma care pathways, surgical reconstructive services, and post-injury functional recovery programs, with implications for specialty surgical reimbursement and care coordination.

Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical context for nerve grafting, common sites of service, and the typical service type. The publication summarizes benchmark considerations and payer coverage themes, outlines relevant policy and coding updates that affect billing and authorization, and presents clinical context to support appropriate coding for reconstructive nerve surgery.

This summary is intended for clinicians, coders, and policy analysts seeking a concise national-level reference on the code’s clinical role, expected settings of service, and the payer landscape influencing access and reimbursement for peripheral nerve reconstruction procedures.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 64890nerve graftperipheral nerve reconstructionhand surgeryfoot surgerysurgical codingreconstructive surgerytrauma care

Billing Code Overview

CPT code 64890 describes a surgical procedure that uses a healthy nerve segment no longer than 4 cm to replace a damaged portion of a nerve in a hand or foot. The procedure aims to restore sensory and/or motor function after nerve injury or transection due to trauma.

Service Type: Nerve grafting / peripheral nerve reconstruction

Typical Site of Service: Operating room; outpatient surgical center; inpatient hospital when indicated

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

Clinical & Coding Specifications

Clinical Context

A 32-year-old right-handed construction worker presents after a work-related laceration to the volar aspect of the distal forearm with complete transection of the median nerve resulting in loss of sensation in the palmar thumb and index finger and weakness of thumb opposition. After initial wound management and nerve exploration in the emergency setting, the surgeon determines a primary repair is not feasible because of a 3.5 cm segmental nerve loss. The planned procedure is autogenous nerve autograft reconstruction using a healthy donor nerve segment no longer than 4 cm to bridge the defect in the median nerve to restore motor and sensory function in the hand. The typical clinical workflow includes preoperative evaluation and informed consent, perioperative nerve exposure and preparation, harvest of the donor nerve graft (commonly sural or a sensory branch), microsurgical coaptation of the graft to the proximal and distal nerve stumps under magnification, hemostasis and layered wound closure, and postoperative immobilization with scheduled hand therapy and serial neurovascular assessments.

Typical Site of Service

The procedure is most commonly performed in an inpatient or outpatient ambulatory surgical center (ASC) setting under regional or general anesthesia in an operating room equipped for microsurgery.

Typical Patient Scenario

Young to middle-aged adult with traumatic nerve transection in the hand or distal forearm
Delayed presentation when tension-free primary repair is not possible due to segmental loss up to 4 cm
Indication: restoration of sensory and/or motor function following nerve injury or avulsion
Postoperative course: inpatient recovery or same-day discharge depending on facility and patient comorbidities with referral to occupational/hand therapy for rehabilitation and serial EMG/nerve conduction testing for functional assessment.

Coding Specifications

CPT 64907: Reversal of Prior Nerve Transfer After Nerve Restoration

CPT-64886-NERVE-GRAFT-HEAD-NECK-GRAFT-LONGER-THAN-4CM

CPT 64886: Nerve Graft, Head and Neck, Donor Segment >4 cm

CPT-64905-NERVE-TRANSFER-RECONSTRUCTIVE-PERIPHERAL-NERVE-SURGERY

CPT 64905: Nerve Transfer for Peripheral Nerve Reconstruction

CPT-64898-MULTIPLE-STRAND-NERVE-GRAFT-PERIPHERAL-NERVE-REPAIR

CPT 64898: Multiple Strand Nerve Graft for Peripheral Nerve Repair

CPT-64911-AUTOGENOUS-VEIN-NERVE-GRAFT-REPAIR

CPT 64911: Nerve Repair with Autogenous Vein Graft

CPT-64912-NERVE-GRAFT-REPAIR-FIRST-STRAND

CPT 64912: Nerve Graft Repair Using Donor Nerve, First Strand

CPT-64913-NERVE-TISSUE-GRAFT-ADDITIONAL-NERVE-STRAND

CPT 64913: Nerve Tissue Graft, Each Additional Nerve Strand

CPT-64892-NERVE-GRAFT-UP-TO-4CM-UPPER-LOWER-EXTREMITY

CPT 64892: Single-Strand Nerve Graft for Arm or Leg (≤4 cm)

CPT-64891-NERVE-GRAFT-HAND-FOOT-LONG-SEGMENT

CPT 64891: Autologous Nerve Graft for Hand or Foot (>4 cm)

CPT-64897-NERVE-GRAFT-MULTIPLE-STRAND-UPPER-OR-LOWER-EXTREMITY

CPT 64897: Multiple Strand Nerve Graft for Arm or Leg Repair

Showing 1–10 of 17

Modifier	Description	When to Use
`26`	Professional component	When billing for only the physician’s professional interpretation component of a service (rare for this procedure).
`50`	Bilateral procedure	When identical nerve grafting is performed on both hands or both feet in the same operative session.
`51`	Multiple procedures	When more than one distinct surgical procedure is performed during the same operative session in addition to the nerve graft.
`52`	Reduced services	When the service is partially reduced or not completed as originally planned.
`53`	Discontinued procedure	If the procedure is started but discontinued for reasons unrelated to the patient’s condition.
`59`	Distinct procedural service	When another procedure performed during the same session is distinct and unrelated to the nerve graft (to indicate separate services).
`62`	Two surgeons	When two surgeons work together as primary surgeons performing distinct portions of the nerve reconstruction.
`78`	Unplanned return to OR for related procedure by same surgeon	When the patient returns to the operating room for a related complication or revision under the same surgeon.
`79`	Unrelated procedure or service by the same physician during the postoperative period	(Note: `79` is not in the provided list; not included.)
`LT`	Left side	When the procedure is performed on the left hand or foot.
`RT`	Right side	When the procedure is performed on the right hand or foot.
`54`	Surgical care only	When billing only for the surgical component and another provider bills for postoperative care.
`55`	Postoperative management only	When billing only for postoperative management (e.g., another surgeon performed the operation).
`22`	Increased procedural services	When the work required is substantially greater than typically required for this procedure.
`59`	Distinct procedural service	(Duplicate entry avoided — see above.)

Taxonomy Code	Specialty	Notes
207P00000X	Orthopedic Surgery	Hand and upper extremity surgeons commonly perform nerve grafting in traumatic cases.
207XS0101X	Plastic Surgery	Microsurgical nerve reconstruction and grafting in the hand and foot.
208400000X	General Surgery	In some centers, general surgeons with peripheral nerve expertise perform grafting.
207RH0000X	Physical Medicine & Rehabilitation	Manages postoperative rehabilitation; not primary surgeon but part of care team.
2084P0800X	Hand Surgery (Subspecialty)	Surgeons with focused hand surgery training perform complex nerve repairs and grafts.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S64.241A`	Laceration of median nerve at forearm level, left forearm, initial encounter	Represents traumatic transection of a hand/forearm nerve requiring grafting to restore function.
`S64.242A`	Laceration of median nerve at forearm level, right forearm, initial encounter	Same as above for right-sided injury.
`S54.021A`	Laceration of ulnar nerve at forearm level, left forearm, initial encounter	Ulnar nerve transections in the hand/forearm commonly require grafting for motor/sensory restoration.
`S54.022A`	Laceration of ulnar nerve at forearm level, right forearm, initial encounter	Right-sided ulnar nerve transection code relevant to repair and grafting.
`S64.141A`	Laceration of radial nerve at forearm level, left forearm, initial encounter	Radial nerve injuries in the distal forearm/hand can require segmental resection and grafting.
`T79.A11A`	Traumatic amputation of right thumb (initial encounter)	Partial amputations with nerve loss may necessitate nerve grafting during reconstruction.
`G56.01`	Carpal tunnel syndrome, right upper limb	Although primarily decompression, severe chronic nerve damage may require reconstructive procedures in select cases.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`69990`	Microsurgical techniques, requiring use of operative microscope (list separately in addition to primary procedure)	Frequently reported in conjunction with nerve grafting when operative microscope is used for microsurgical coaptation.
`64721`	Neuroplasty and/or transposition; ulnar nerve at elbow (epicondylectomy, transposition)	Performed for nerve decompression or transposition procedures that may accompany or precede grafting in complex injuries.
`64851`	Neuroplasty and/or transposition, other than ulnar nerve, each nerve	May be performed on adjacent nerve segments as part of the operative plan prior to or during grafting.
`20610`	Arthrocentesis, aspiration and/or injection; major joint or bursa (e.g., for diagnostic or therapeutic injections)	Occasionally used perioperatively for associated joint issues; less commonly directly related.
`64885`	Neuroplasty of peripheral nerve, repair with conduit or vein graft, less than 3 cm	Alternative nerve reconstruction technique; selected when synthetic conduit or vein grafts are used instead of autograft.

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