Carpal Tunnel Release Surgical Techniques
Defines medical necessity, site-of-service review, documentation, investigational techniques, and coding for endoscopic and open carpal tunnel release surgery for carpal tunnel syndrome for Premera Bluecross members (excludes Medicare Advantage).
Site of Service Ambulatory Service Center (ASC) Select Diagnostic or Surgical Procedures criteria added, effective for dates of service on or after June 5, 2026 following 90-day provider notification.
Carpal tunnel release surgery medical necessity criteria simplified to require either electrodiagnostic confirmation or CTS-6 >12; added investigational status for ultrasound-guided percutaneous intracarpal tunnel balloon dilation release.
CPT code 64728 added, effective 01/01/26.
Provocative tests and CTS-6 included to simplify medical necessity review (interim review 12/01/25).
Added header that site of service review does not apply to Indian Health Services (IHS) facilities (06/01/26).