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    v1.0.28
    OpenPayerBilling CodesOutpatient PPSHCPCS hcpcs-c9356-tenon-protector-tendon-matrix-sheet
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    HCPCS Level II C9356: Tendon Protector Sheet, Collagen/GAG Matrix

    HCPCS Level II code C9356 describes a porous, cross-linked collagen and glycosaminoglycan matrix tendon protector sheet (Tenoglide) billed per square centimeter; this is a surgical implantable soft-tissue scaffold used to reinforce or protect tendons during operative tendon repair or reconstruction, typically supplied and applied in the operating room as part of a surgical procedure for hand, wrist, or extremity tendon surgery.

    For related coverage guidance, see recent payer policy updates: Cardiac Computed Tomography (CCT)/Coronary Computed Tomographic Angiography (CCTA), Cardiovascular Disease Risk Assessment, Biomarkers for Myocardial Infarction and Chronic Heart Failure.

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient is an adult presenting with a complex flexor tendon injury or degenerative tendon condition of the hand or wrist requiring augmentation during repair. The surgeon performs open tendon repair and applies a porous, cross-linked collagen and glycosaminoglycan matrix tendon protector sheet (C9356) sized and billed per square centimeter to reinforce the repair, limit adhesions, and provide a biologic scaffold. The workflow: preoperative evaluation in the orthopedic or hand surgery clinic (history, exam, imaging such as ultrasound or MRI), informed consent including implant use, intraoperative open repair of the injured tendon under regional or general anesthesia in an operating room or ambulatory surgical center, placement and suturing of the tendon protector sheet to the repair site, wound closure, postoperative hand therapy referral, and follow-up visits for wound check and range-of-motion progression. Typical site of service is an operating room in a hospital outpatient department or ambulatory surgery center for hand/orthopedic procedures.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    26418Repair, flexor tendon, each tendon, primary or secondary; palm to flexor sheath or distal forearmOften performed as the primary tendon repair to which the tendon protector sheet (C9356) is applied.
    26420Repair, flexor tendon, each tendon, proximal to flexor sheath, forearmPerformed for more proximal flexor tendon injuries and may be augmented with the collagen matrix.
    25245Repair, extensor tendon, wrist and/or forearm; primary or secondary repairExtensor tendon repairs in which a protective matrix may be used to minimize adhesions.
    26055Tendon sheath incision (e.g., for trigger finger) and/or explorationDiagnostic or limited procedures on tendon sheaths that can precede definitive repair and augmentation.
    20670Removal of deep implant; tendon or muscle (separate procedure)Performed when prior implants or devices must be removed before placement of a new tendon protector sheet.

    Related Modifiers

    8 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    51Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    81Modifier -81 indicates a physician served as a minimal assistant surgeon for part—not all—of an operative procedure. Use when a physician’s assisting role is limited and does not represent full…- Use CPT modifier -81 when a physician acts as a minimum assistant surgeon who assists during only part (a limited portion) of an operative procedure; append -81 to the primary surgical CPT code to…
    82Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    207X00000XOrthopaedic Surgery PhysicianAn orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated…
    207K00000XAllergy & Immunology PhysicianAn allergist-immunologist is trained in evaluation, physical and laboratory diagnosis, and management of disorders involving the immune system. Select…
    208600000XSurgery PhysicianA general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of s…
    208D00000XGeneral Practice PhysicianA physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.
    367500000XCertified Registered Nurse Anesthetist(1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, prov…
    341800000XMilitary/U.S. Coast Guard TransportTransportation Services · Military/U.S. Coast Guard Transport
    261QR0401XComprehensive Outpatient Rehabilitation Facility (CORF)Ambulatory Health Care Facilities · Clinic/Center
    2251P0200XPediatric Physical TherapistA licensed physical therapist, including but not limited to an individual who is a Board Certified Specialist in Pediatric Physical Therapy, who has d…

    Related Payer Policy Updates

    Specialty: Cardiology1 / 3

    10 rows

    PolicyPayerEffective Date
    Cardiac Computed Tomography (CCT)/Coronary Computed Tomographic Angiography (CCTA)univerahealthcare2026-10-15
    Cardiovascular Disease Risk AssessmentOscar Health2026-10-01
    Biomarkers for Myocardial Infarction and Chronic Heart FailureOscar Health2026-10-01
    Multiple Procedure Payment Reduction for Diagnostic Cardiovascular ProceduresBlue Cross Blue Shield - Maine2026-10-01
    Cardiovascular Disease Risk Assessmentblue cross blue shield - louisiana2026-09-15
    Cardiovascular Disease Risk AssessmentBlue Cross Blue Shield - New Mexico2026-09-04
    Computed Tomography to Detect Coronary Artery CalcificationBluecross Idaho2026-09-01
    Intracoronary Drug Delivery Balloon ProceduresBlue Cross Blue Shield - Rhode Island2026-09-01
    Cardiac Imaging Guidelinesevicore2026-09-01
    Percutaneous Left Atrial Appendage Closure Device for Stroke PreventionAmbetter Georgia2026-08-26

    Related Codes

    HCPCS-C1713-IMPLANTABLE-ANCHOR-SCREW-BONE-FIXATION

    HCPCS C1713: Anchor/Screw for Bone or Soft Tissue Fixation (Implantable)

    HCPCS-C1714-TRANSLUMINAL-DIRECTIONAL-ATHERECTOMY-CATHETER

    HCPCS C1714: Catheter, transluminal atherectomy, directional

    HCPCS-C1715-BRACHYTHERAPY-NEEDLE

    HCPCS C1715: Brachytherapy Needle

    HCPCS-C1716-BRACHYTHERAPY-GOLD-198-SOURCE

    HCPCS C1716: Brachytherapy Source, Gold-198, Per Source

    HCPCS-C1717-HDR-BRACHYTHERAPY-IRIDIUM-192-SOURCE

    HCPCS C1717: HDR Iridium-192 Brachytherapy Source, Per Source

    HCPCS-C1719-BRACHYTHERAPY-IRIDIUM-192-SOURCE-NON-STRANDED

    HCPCS C1719: Brachytherapy Source, Iridium-192, Non-Stranded

    HCPCS-C1721-IMPLANTABLE-DUAL-CHAMBER-CARDIOVERTER-DEFIBRILLATOR

    HCPCS C1721: Cardioverter-Defibrillator, Dual Chamber (Implantable)

    HCPCS-C1724-ROTATIONAL-TRANSLUMINAL-ATHERECTOMY-CATHETER

    HCPCS Level II C1724: Rotational Transluminal Atherectomy Catheter

    HCPCS-C1725-TRANSLUMINAL-ANGIOPLASTY-CATHETER-NON-LASER

    HCPCS Level II C1725: Transluminal Angioplasty Catheter, Non-Laser

    HCPCS-C1726-NON-VASCULAR-BALLOON-DILATATION-CATHETER

    HCPCS C1726: Catheter, Balloon Dilatation, Non-Vascular

    Showing 1–10 of 603

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    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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