CPT 64911 Autogenous Vein Nerve Graft Reimbursement

CPT code 64911 represents surgical repair of a peripheral nerve using an autogenous vein graft harvested from the patient. This technique is used when direct nerve coaptation is not possible and aims to restore continuity and provide a conduit for axonal regeneration. The code is clinically important across specialties that manage traumatic or iatrogenic nerve injuries, including plastic surgery, hand surgery, and peripheral nerve surgery.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a national-oriented account of the clinical context for use of CPT code 64911, typical settings where the procedure is performed, and the types of documentation and procedural descriptors that commonly accompany billing for vein graft nerve repair. The publication outlines benchmarks and coverage considerations where available, highlights relevant coding relationships, and summarizes typical procedural utilization patterns and policy implications for payers and providers. Data not available in the input are noted where applicable.

Billing Code Overview

CPT code 64911 describes surgical repair of a nerve using an autogenous vein graft, a vein harvested from the patient and used to bridge or reconstruct a damaged peripheral nerve. The procedure is a form of nerve grafting performed when primary end-to-end nerve repair is not feasible due to tissue loss or a gap between nerve ends.

Service type: Surgical peripheral nerve reconstruction using autogenous vein graft
Typical site of service: Operative setting such as an ambulatory surgical center or hospital operating room

Clinical Context

A typical patient is an adult who sustained a traumatic peripheral nerve injury (for example, a segmental injury of the ulnar nerve after a deep laceration to the forearm) where direct end-to-end repair is not possible due to a nerve gap. The patient presents with motor weakness, sensory loss, and positive findings on nerve conduction studies confirming discontinuity or significant segmental loss. The clinical workflow includes preoperative evaluation (history, physical examination, imaging as needed, and electrodiagnostic testing), informed consent discussing nerve grafting options, intraoperative harvest of an autogenous vein (commonly a segment of the saphenous vein or a superficial arm vein), preparation of the vein graft and nerve ends under magnification, microsurgical interposition of the vein graft as a conduit for regenerating axons often with nerve fascicle suturing or placement of nerve autograft within the vein, and postoperative immobilization, pain control, and rehabilitation with serial neurovascular and functional assessments. Typical site of service is an acute care hospital operating room or ambulatory surgical center equipped for microsurgery. Service type is operative microsurgical peripheral nerve repair using an autogenous vein graft (64911).

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when the procedure involves substantially greater work than typical (extensive dissection, prolonged operative time).

Taxonomy Code	Specialty	Notes
207P00000X	Orthopedic Surgery	Orthopedic surgeons commonly perform peripheral nerve repairs associated with extremity trauma.
208000000X	General Surgery	Trauma and general surgeons may perform peripheral nerve grafting in appropriate settings.
2084P0800X	Plastic Surgery	Plastic/reconstructive surgeons frequently perform microsurgical nerve repairs and grafting.
363L00000X	Neurological Surgery	Neurosurgeons manage complex peripheral nerve and plexus reconstructions.
207K00000X	Hand Surgery	Hand surgeons (often orthopedic or plastic fellowship-trained) commonly perform upper extremity nerve grafting.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
Data not available in the input.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`64718`	Neuroplasty and/or transposition; peripheral nerve, other than specified	May be performed for decompression or mobilization of the nerve before or instead of grafting when adhesions or entrapment contribute to dysfunction.
`64831`	Repair, nerve, direct; with graft, conduit, or tube (includes harvesting of graft)	Related technique codes for nerve repair using conduits or grafts; used when synthetic or processed nerve conduits are used rather than autogenous vein conduit.
`20610`	Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip)	May be performed perioperatively for joint management in cases with associated joint pathology; not routinely part of the nerve graft procedure.
`19364`	Breast reconstruction with other technique (includes nerve coaptation when performed)	Included when nerve grafting is performed as part of reconstruction procedures in other anatomic regions (example context dependent).
`69990`	Microscopic surgical techniques, requiring use of an operating microscope (list separately in addition to code for primary procedure)	Billed in addition when an operating microscope is necessary for microsurgical nerve grafting procedures like `64911`.

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Summary & Overview

CPT 64911: Nerve Repair with Autogenous Vein Graft