**Hand Surgery & Carpal Tunnel Release CPT Coding Guide**

Introduction

Hand surgeries, including carpal tunnel release and tendon repairs, are among the most commonly performed orthopedic procedures. Proper CPT coding is critical to ensure accurate reimbursement and to prevent denials due to bundling errors or incorrect modifier usage. This guide covers the key CPT codes for hand surgery, including carpal tunnel release, tendon repairs, and fracture management, along with billing guidelines and a final reference table including CPT descriptions and RVUs.

Understanding Hand Surgery & Carpal Tunnel Release

Hand surgery includes a variety of procedures for nerve compression (e.g., carpal tunnel syndrome), tendon injuries, and fractures. Depending on whether the procedure is performed open or endoscopic, different CPT codes apply.

CPT Codes for Hand Surgery & Carpal Tunnel Release

Carpal Tunnel Release CPT Codes

  • 64721 – Neuroplasty and/or transposition; median nerve at carpal tunnel.

    • Used for open carpal tunnel release.
    • Bundling considerations: Often bundled with tenosynovectomy (26123) if performed in the same session.

  • 29848 – Endoscopic carpal tunnel release.

    • Used when carpal tunnel release is performed endoscopically instead of open surgery.
    • Higher reimbursement due to increased complexity.

Flexor & Extensor Tendon Repair Codes

  • 26350 – Repair or advancement, flexor tendon, finger.

    • Used for direct repair of a single flexor tendon in a finger.

  • 26410 – Repair of extensor tendon, primary or secondary, without graft.

    • Used for extensor tendon repairs in the hand or wrist.

  • 26525 – Tenodesis of finger tendon, single.

    • Used when reattaching or repositioning a tendon to restore function.

Fracture & Joint Surgery Codes

  • 26727 – Open treatment of metacarpal fracture, single.

    • Used for open reduction and internal fixation (ORIF) of a metacarpal fracture.

  • 26735 – Percutaneous pinning of metacarpal fracture.

    • Used when fractures are treated with percutaneous pinning rather than open fixation.

  • 26123 – Tenosynovectomy, flexor tendon, palm and/or finger, single digit.

    • Often performed alongside carpal tunnel release.

  • 26536 – Arthroplasty, interphalangeal joint, with implant.

    • Used for joint replacement in fingers due to arthritis or trauma.

Billing Guidelines & Modifier Usage

  • Common Modifiers:

    • -RT/-LT – Identifies right or left hand.
    • -59 – Used when reporting separately billable procedures.
    • -51 – Applied when multiple surgeries are performed at the same session.

  • Bundling Considerations:

    • 64721 (carpal tunnel release) and 26123 (tenosynovectomy) may bundle—check payer-specific policies.
    • Tendon repairs may be bundled if performed in the same operative field.

Common Denials & How to Avoid Them

  • Bundling Errors: Ensure proper use of modifiers if reporting multiple procedures.
  • Lack of Medical Necessity: Document nerve conduction studies for carpal tunnel syndrome cases.
  • Incorrect Modifier Use: Use -59 modifier when billing procedures that are normally bundled.

Final CPT Code Table: Descriptions & RVUs

CPT Code Description RVU
64721 Neuroplasty; carpal tunnel release 7.48
29848 Endoscopic carpal tunnel release 9.72
26350 Repair of flexor tendon, finger 8.45
26410 Repair of extensor tendon, hand 7.98
26525 Tenodesis of finger tendon 6.90
26727 Open treatment of metacarpal fracture 10.34
26735 Percutaneous pinning of metacarpal fracture 8.75
26123 Tenosynovectomy, flexor tendon, single digit 6.23
26536 Arthroplasty, interphalangeal joint, with implant 12.11

Conclusion

Accurate CPT coding for hand surgery and carpal tunnel release is essential for maximizing reimbursement and reducing denials. Understanding bundling rules, modifier application, and payer-specific guidelines will help ensure accurate claims.

If this guide was useful, check out our other orthopedic CPT coding guides on rotator cuff repair, knee arthroscopy, and spinal fusion!