CPT 64907 Reversal Benchmarks & Policy | OpenPayer

Summary & Overview

CPT 64907: Reversal of Prior Nerve Transfer After Nerve Restoration

CPT code 64907 represents surgical reversal of a prior nerve transfer after the original injured nerve has been repaired or restored. This complex reconstructive procedure is most relevant for severe peripheral nerve trauma, such as extensive brachial plexus injuries where initial donor-to-recipient transfers were used to regain function and later reversed when the native nerve recovered or alternative repairs became feasible. Nationally, CPT code 64907 matters because it captures a distinct, resource-intensive surgical encounter with implications for clinical decision-making, postsurgical rehabilitation, and specialty payment policy for nerve reconstruction.

Key payers in the review include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a clinical and coding overview, expected sites of service and procedural context, and a summary of common billing modifiers and administrative considerations where available. The publication also outlines benchmarking elements and policy updates relevant to reconstructive peripheral nerve surgery, as well as guidance on documentation elements typically associated with coding this service.

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

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 64907nerve transfer reversalperipheral nerve surgerybrachial plexusreconstructive surgerysurgical codingoperative procedurenerve reconstruction

Billing Code Overview

CPT code 64907 describes a surgical procedure in which the provider reverses a previously performed transfer of a donor nerve back to its original or alternate recipient nerve after the damaged recipient nerve has been restored. This operation is typically used in complex peripheral nerve injuries, including severe brachial plexus injuries where a nerve laceration was irreparable, nerve compression required correction, or a nerve root was avulsed from the spinal cord and later reconstructed.

Service type: Complex peripheral nerve reconstructive surgery
Typical site of service: Inpatient or outpatient surgical setting, commonly performed in hospital operating rooms or specialized ambulatory surgical centers for reconstructive peripheral nerve procedures

Clinical & Coding Specifications

Clinical Context

A 32-year-old male construction worker sustains a high-energy shoulder avulsion during a motorcycle crash resulting in a brachial plexus injury with an irreparable injury to the upper trunk. After initial stabilization, staged reconstructive planning includes nerve transfers to restore elbow flexion and shoulder function. Once the originally transferred donor nerve (for example, a spinal accessory or intercostal nerve) is no longer needed or the previously damaged recipient nerve has regained continuity after nerve grafting, the surgeon performs a reversal of the prior nerve transfer to restore donor nerve function or reposition transfers for improved motor recovery. The clinical workflow includes preoperative imaging and electrodiagnostic testing, informed consent detailing risks and goals, intraoperative nerve identification and neurolysis, reversal of the prior coaptation, and microsurgical reattachment of the donor nerve to its original target or alternate recipient. Postoperative care includes wound management, immobilization as indicated, early hand/shoulder therapy coordination, and serial clinical and electrodiagnostic follow-up to monitor reinnervation and motor recovery.

Coding Specifications

Modifier	Description	When to Use
`62`	Two surgeons	Use when two surgeons of different specialties work concurrently and each performs distinct parts of the reversal procedure.

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

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

CPT 64901: Additional Single-Strand Nerve Graft Repair

CPT-64885-NERVE-GRAFT-HEAD-NECK

CPT 64885: Nerve Graft for Head or Neck, Up to 4 cm

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

CPT 64911: Nerve Repair with Autogenous Vein Graft

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

CPT 64910: Nerve Reconstruction Using Conduit or Vein Graft

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

CPT 64913: Nerve Tissue Graft, Each Additional Nerve Strand

CPT-64895-MULTIPLE-STRAND-NERVE-GRAFT-HAND-FOOT-UP-TO-4CM

CPT 64895: Multiple Strand Nerve Graft for Hand or Foot (Up to 4 cm)

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

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

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

CPT 64898: Multiple Strand Nerve Graft for Peripheral Nerve 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
208X00000X	Orthopaedic Surgery	Orthopedic surgeons specializing in peripheral nerve and brachial plexus reconstruction frequently perform revisions and nerve transfer reversals.
2084P0800X	Plastic Surgery	Microsurgical and peripheral nerve reconstruction, including nerve transfers and reversals, are commonly performed by plastic surgeons with hand/nerve expertise.
207K00000X	Neurological Surgery	Neurosurgeons with peripheral nerve specialization may perform complex brachial plexus nerve reconstructions and reversals.
207L00000X	Hand Surgery	Hand surgeons (orthopedic or plastic certified) involved in upper extremity peripheral nerve procedures may perform reversal procedures.
208000000X	Surgery	General surgeons are less commonly the primary operators but may participate in multidisciplinary cases.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S04.121A`	Injury of nerve root of cervical spinal cord, initial encounter	Cervical root avulsion may lead to brachial plexus deficits necessitating nerve transfer and later reversal after restoration.
`S14.10XA`	Injury of nerve root of neck, unspecified, initial encounter	Represents root injuries in the cervical region affecting upper extremity nerves considered for transfer/reversal.
`S48.091A`	Injury of musculocutaneous nerve, initial encounter	Peripheral nerve lacerations of major upper-extremity nerves that may receive donor transfers and later reversal.
`S46.011A`	Strain of muscles and tendons at shoulder and upper arm level, right arm, initial encounter	Severe traumatic injuries around the brachial plexus region often accompany nerve injuries needing reconstructive reversal procedures.
`G54.0`	Brachial plexus disorders	Primary diagnosis when brachial plexus injury causes functional loss and is treated with transfers and possible reversal.
`T79.A11A`	Traumatic amputation of shoulder girdle, ischaemia, initial encounter	Severe trauma scenarios that can involve complex nerve injury patterns requiring staged reconstruction and occasional reversal.
`M84.4X0A`	Stress fracture, unspecified site, initial encounter	Included when complex trauma with osseous injury is part of the overall reconstructive plan involving nerve procedures.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`64907`	Reversal of nerve transfer (donor nerve reversed to damaged recipient nerve after restoration)	Primary procedure: reversal of a prior nerve transfer following restoration of the damaged nerve.
`64718`	Neuroplasty and/or transposition; major peripheral nerve (eg, brachial plexus, sciatic nerve)	Performed when extensive neurolysis or decompression of the injured nerve is required prior to or during reversal.
`64856`	Repair of nerve, with or without graft; major peripheral nerve	Used when nerve grafting is performed in the same operative episode to restore continuity before or in conjunction with reversal.
`69990`	Microsurgical techniques (list separately in addition to code for primary procedure)	Billed when specialized microsurgical techniques are used during nerve coaptation or transfer reversal.
`95907`	Nerve conduction studies; motor and sensory, single limb, complete study	Performed pre- or postoperatively for electrodiagnostic assessment of nerve recovery and to guide timing of reversal.

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