CPT Billing and Coding of 26040 and 20550

CPT CODES AND Descriptions

26040 - Fasciotomy, palmar (eg, Dupuytren's contracture); percutaneous - Average fee amount $300 - $350


20550 - Injection(s); single tendon sheath, or ligament, aponeurosis (eg, plantar "fascia")




Billing and Coding of 26040 and 20550

Coast Service Options, Inc. (FCSO) that providers may not be billing CPT code 26040 correctly.CPT code 26040 Fasciotomy, palmar (eg, Dupuytren?s contracture); percutaneous and CPT 26045, open partial, have a clear descriptor referring to palmar fasciotomy. There is no reference to one or multiple tendon releases and there is one palmar fascia per hand. The fascia covers the tendons of the palm of the hand. Therefore the code should be billed once per hand.

CPT 4 coding is based on Level I and II procedure coding terminology. If a bilateral procedure is performed, then the CPT code 26040 or 26045 should be billed with modifier RT, LT, or 50. CPT code 26040 or 26045 cannot be billed more than once per hand and the use of certain modifiers would be inappropriate, i.e., F1, F2, etc.

When CPT code 20550 Injection(s); tendon sheath, or ligament, aponeurosis) is billed in addition to CPT code 26040 or 26045, it must be a separate service. CPT code 20550 Injection(s); tendon sheath, or ligament, aponeurosis (e.g., plantar ?fascia?) has editing related to CCI (and is considered a column 2 Code to 26040 or 26045 ? a component of CPT code 26040 or 26045). Documentation must support the appropriate use of a modifier 59 to bypass CCI edits. The documentation should be available to FCSO upon request.

There is no local coverage determination (LCD) for CPT code 26040 or 26045, but FCSO does have an LCD for CPT code 20550 that further defines medical necessity, which is the focus of a LCD.Italicized and/or quoted material is excerpted from the American Medical Association Current Procedural Terminology. CPT codes, descriptions and other data only are copyrighted 2005 American Medical Association (or other such date of publication of CPT).


o ICD Code 728.6 CPT Code 26040 (Percutaneous Fasciotomy - one finger)

o ICD Code 728.79 CPT Code 20550 (Steroid injection Dupuytren's nodule)  and occasionally


HCPCS/CPT Codes Max Units of Service

26040           2


Bilateral Procedure Reduction List

The following table applies to Tufts Health Plan Commercial contracted providers. The table below consists of CPT and HCPCS procedure codes that will be subject to a bilateral procedure reduction. The procedure codes contained within this table will be accepted by Tufts Health Plan and may have an impact on compensation. The absence or presence of a procedure code is not an indication and/or guarantee of coverage and or payment.

CPT/HCPCS Procedure Code

26025

26030

26037

26040

26045


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