Summary & Overview

CPT 64902: Secondary Multiple-Strand Nerve Graft Repair

CPT code 64902 represents a secondary multiple-strand nerve graft repair performed in the same operative session as an initial nerve bridge or repair. The procedure uses a portion of an unrelated donor nerve to bridge or repair the injured portion of a subsequent nerve. This code captures additional nerve grafting complexity that occurs during a single surgical encounter and can affect operative coding, bundling decisions, and reimbursement considerations nationally.

Key payers covered in this national overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical procedure and typical sites of service, followed by benchmarking and policy context where available. The publication outlines common billing considerations related to performing an additional nerve graft during the same session as an initial repair, summarizes typical contractual and Medicare billing implications, and highlights coding scenarios that commonly prompt payer review.

The analysis is intended for coding professionals, practice managers, and surgical teams involved in peripheral nerve reconstruction. It provides clinical context, guidance on documentation focal points, and an overview of payer patterns and policy updates relevant to claims with CPT code 64902. Data not included in the input—such as specific ICD-10 pairings, detailed modifier usage by payer, and associated taxonomies—is noted as unavailable where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare64902CPTnerve graftperipheral nerve repairsurgical codingoperative codingmicrosurgeryambulatory surgical centerhospital outpatient

Billing Code Overview

CPT code 64902 describes a secondary multiple-strand nerve graft repair performed during the same operative session as an initial nerve bridge or repair. The procedure uses a portion of an unrelated donor nerve to bridge or repair the injured portion of a subsequent nerve following an earlier repair in the same operative encounter.

Service type: Surgical — peripheral nerve repair with multiple-strand grafting, additional nerve

Typical site of service: Hospital operating room or ambulatory surgical center, where operative nerve reconstruction and microsurgical techniques are performed.

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 42-year-old male worker presents after a high-energy forearm laceration with transection of multiple peripheral nerves confirmed at surgery. During the initial operative session the surgeon performs primary repair of one nerve and, at the same session, harvests an autologous sensory nerve graft (multiple-strand graft using a portion of an unrelated donor nerve) to bridge a second injured nerve in the same limb. The procedure documented is a subsequent multiple-strand nerve graft repair performed in the same operative session as the initial nerve repair. Typical workflow includes preoperative evaluation, intraoperative nerve exploration and assessment, harvest of the donor nerve segment (sensory donor such as the sural nerve), preparation of multiple nerve strands, microsurgical coaptation to bridge the injured nerve segment, and standard wound closure. Postoperative care includes immobilization, pain control, wound checks, and scheduled follow-up for sensory and motor recovery assessments and possible physical therapy referrals.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work substantially greater than typical for `64902` is documented (e.g., extensive dissection, prolonged operative time).
`23`	Unusual anesthesia	Use when the procedure is performed under general anesthesia but the documentation indicates significant medical condition making local/regional anesthesia impossible.
`26`	Professional component	Use if billing only the professional component separate from facility billing (rare for this surgical code).
`50`	Bilateral procedure	Use when identical bilateral `64902` procedures are performed and payer accepts bilateral modifier.
`52`	Reduced services	Use when the procedure is started but not completed as documented (partial grafting performed).
`53`	Discontinued procedure	Use when the procedure is aborted due to unforeseen circumstances before completion.
`62`	Two surgeons	Use when two surgeons of different specialties worked together as primary surgeons on the same operative field.
`63`	Procedure on infant under 4 kg	Use when patient weight criteria met and documentation supports.
`78`	Return to operating room for related procedure during global period	Use when a related unplanned return to OR for a complication of `64902` occurs within the global period.
`79`	Unrelated procedure or service by the same physician during the postoperative period	Use when a completely unrelated procedure is performed during the global period (note: `79` is not in the provided list; not included).
`80`	Assistant surgeon	Use when an assistant surgeon provides assistance at surgery and assistant surgeon billing is permitted.
`81`	Minimum assistant surgeon	Use when a minimal assistant role is documented.
`82`	Assistant surgeon when qualified resident unavailable	Use when an assistant surgeon is required because a qualified resident is unavailable.
`QK`	Medical direction of two, three, or four qualified individuals	Use for anesthesia medical direction when applicable to concurrent anesthesia services.

Taxonomy Code	Specialty	Notes
207P00000X	Orthopedic Surgery	Orthopedic hand and peripheral nerve surgeons commonly perform peripheral nerve grafting.
208000000X	General Surgery	Trauma and peripheral nerve repairs in emergent settings may be performed by general surgeons with microsurgical training.
2084P0800X	Plastic Surgery	Plastic and reconstructive surgeons frequently perform microsurgical nerve grafting and repair.
207L00000X	Neurological Surgery	Neurosurgeons perform complex peripheral nerve repairs in select cases.
208VP0000X	Vascular Surgery	May be involved when vascular injury coexists requiring combined procedures.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S54.021A`	Traumatic rupture of median nerve at forearm level, right arm, initial encounter	Direct traumatic nerve transection commonly requiring graft repair such as `64902`.
`S54.041A`	Traumatic rupture of radial nerve at forearm level, right arm, initial encounter	Radial nerve injuries with segmental loss may require multiple-strand nerve grafting.
`S64.031A`	Traumatic amputation of thumb(s) at wrist level, initial encounter	Associated soft tissue and nerve injuries where grafting may be performed during reconstruction.
`G56.0`	Carpal tunnel syndrome	Chronic compressive neuropathy less commonly treated with grafting; included when secondary nerve reconstruction is required after decompression failure.
`S48.111A`	Traumatic rupture of musculocutaneous nerve, right shoulder and upper arm, initial encounter	Proximal peripheral nerve injuries that may necessitate grafting when direct repair is not feasible.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`64831`	Neuroplasty and/or transposition; ulnar nerve at elbow	May be performed in same operative setting when ulnar nerve requires decompression or transposition in addition to grafting.
`64718`	Neuroplasty and/or transposition; other peripheral nerve	Commonly performed in conjunction with nerve grafting when scarred nerve segments require neuroplasty.
`20680`	Removal of implant; deep (e.g., buried wire)	May be performed before nerve repair if retained hardware or foreign body is present obstructing nerve reconstruction.
`15738`	Muscle, myocutaneous, or fasciocutaneous free flap with microvascular anastomosis	Performed when soft-tissue coverage is required concurrently with nerve reconstruction; often coordinated in reconstructive cases.
`64450`	Nerve block; other peripheral nerve or branch	Used perioperatively for regional anesthesia or postoperative analgesia adjunctive to surgical nerve repair.