CPT 64891 Autologous Nerve Graft Reimbursement | OpenPayer

Summary & Overview

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

CPT code 64891 defines an autologous nerve graft procedure using a healthy nerve segment longer than 4 cm to replace a damaged portion of a nerve in the hand or foot. This surgical intervention is performed to restore sensory and/or motor function following traumatic nerve injury. The code is clinically significant for trauma, orthopedics, plastic surgery, and peripheral nerve specialists because it denotes a more extensive grafting procedure than shorter-segment repairs and has implications for operative planning, resource use, and postoperative rehabilitation.

Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise review of clinical context, typical sites of service, and service type, along with benchmarks and payment considerations where available. The publication summarizes common modifier usage and related billing practice considerations, highlights clinical indications and expected outcomes, and points to common gaps where data was not provided. This material is written for a national audience and is intended to inform coding accuracy, prior authorization discussions, and clinical documentation that supports appropriate billing for complex peripheral nerve reconstruction.

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Billing Code Overview

CPT code 64891 describes an operative procedure in which a surgeon harvests a healthy nerve segment longer than 4 cm to replace a damaged portion of a nerve in a hand or foot. The procedure is intended to restore sensory and/or motor function after nerve injury or transection caused by trauma.

Service type: Autologous nerve grafting/nerve reconstruction for peripheral nerves of the hand or foot
Typical site of service: Operating room or ambulatory surgical center, performed under regional or general anesthesia

Clinical & Coding Specifications

Clinical Context

A 34-year-old manual laborer presents after a deep laceration to the volar wrist with loss of index finger sensation and partial motor deficit of finger abduction. Examination and electrodiagnostic testing confirm a segmental defect of a digital sensory nerve and partial motor branch injury not amenable to primary end-to-end repair due to a nerve gap >4 cm. The surgical plan is an autologous nerve graft using a healthy donor nerve segment longer than 4 cm to bridge the defect and restore both sensory and/or motor continuity in the hand. The clinical workflow includes preoperative localization and mapping of injured and donor nerves, informed consent specific to graft harvest morbidity, intraoperative nerve exploration, resection of scarred nerve ends, measurement of the gap, harvest of the donor nerve segment (commonly sural or medial antebrachial cutaneous nerve), microsurgical coaptation with fine sutures and/or fibrin glue under magnification, hemostasis, layered closure, and postoperative immobilization and hand therapy. Typical perioperative documentation includes indication, precise gap length, donor nerve identity, laterality, anesthesia type, operative time, findings of nerve continuity and tension-free repair, and plans for follow-up rehabilitation and electrodiagnostic reassessment.

Coding Specifications

Modifier	Description	When to Use
`11`	Urgent/Emergent service	When the procedure is performed for an urgent traumatic nerve injury requiring prompt repair.

CPT 64898: Multiple Strand Nerve Graft for Peripheral Nerve Repair

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

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

CPT-64896-MULTIPLE-STRAND-NERVE-GRAFT-HAND-FOOT

CPT 64896: Multiple Strand Nerve Graft for Hand or Foot Repair

CPT-64902-SECONDARY-MULTIPLE-STRAND-NERVE-GRAFT-REPAIR

CPT 64902: Secondary Multiple-Strand Nerve Graft Repair

CPT-64910-NERVE-RECONSTRUCTION-WITH-CONDUIT-OR-VEIN-GRAFT

CPT 64910: Nerve Reconstruction Using Conduit or Vein Graft

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

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

CPT-64893-SINGLE-STRAND-NERVE-GRAFT-ARM-LEG-GRAFT-GREATER-THAN-4CM

CPT 64893: Single-Strand Nerve Graft for Arm or Leg (>4 cm)

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

CPT 64911: Nerve Repair with Autogenous Vein Graft

CPT-64901-ADDITIONAL-SINGLE-STRAND-NERVE-GRAFT-REPAIR

CPT 64901: Additional Single-Strand Nerve Graft Repair

CPT-64890-NERVE-GRAFT-RECONSTRUCTION-HAND-FOOT

CPT 64890: Peripheral Nerve Graft for Hand or Foot

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Taxonomy Code	Specialty	Notes
208U00000X	Orthopaedic Hand Surgery	Fellowship-trained surgeons performing complex peripheral nerve reconstructions.
2080P0202X	Plastic Surgery (Hand)	Plastic surgeons with hand surgery focus performing microsurgical nerve grafting.
2084P0800X	General Surgery (Peripheral Nerve)	Surgeons with peripheral nerve expertise who perform nerve grafts.
207R00000X	Physical Medicine & Rehabilitation	Not a surgical provider; manages postoperative rehab and electrodiagnostic follow-up.
207V00000X	Physical Therapist	Provides hand therapy post-op; included as relevant care team taxonomy.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S64.211A`	Laceration of median nerve at forearm level, initial encounter	Common traumatic indication when a hand/forearm nerve is transected requiring grafting.
`S64.311A`	Laceration of ulnar nerve at forearm level, initial encounter	Ulnar nerve injuries to the hand/forearm often require grafts when primary repair is not possible.
`S64.411A`	Laceration of radial nerve at forearm level, initial encounter	Radial nerve sensory/motor defects may be repaired with nerve grafts for significant gaps.
`T79.A11A`	Traumatic amputation of right upper extremity, initial encounter	Severe traumatic injuries with segmental nerve loss where reconstruction with grafting is indicated.
`G56.0`	Carpal tunnel syndrome (median nerve entrapment)	Although typically treated with release, chronic nerve damage or iatrogenic nerve loss may occasionally necessitate grafting.
`M79.2`	Neuralgia and neuritis, unspecified	Represents neuropathic pain conditions that can be associated with nerve injury requiring surgical evaluation.
`S98.011A`	Traumatic amputation of finger(s), initial encounter	Digital amputations with nerve defects where grafting is part of reconstruction.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`64892`	Repair of nerve with graft; using a nerve segment 2 cm or less in length	Alternative code when graft length is ≤2 cm; contrasts with `64891` which requires >4 cm.
`64895`	Repair of nerve with graft; other lengths or complex grafting (unlisted peripheral nerve procedures)	Used for complex or combined nerve grafting not captured by length-specific CPTs; may be used when multiple grafts or conduits are required.
`69990`	Microsurgical techniques (use of operating microscope)	Billed when an operating microscope is used during microsurgical nerve coaptation.
`49568`	Repair of donor-site superficial sensory nerve (example: harvest-related closure)	Represents donor-site management; specific donor nerve harvest codes are typically bundled, but related wound/closure care may be coded separately if distinct.
`95886`	Needle electromyography; limited study	Used in preoperative or postoperative electrodiagnostic evaluation to document denervation or reinnervation in affected muscles.

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