2025 CPT code 64891
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Surgery - Neurorrhaphy With Nerve Graft, Vein Graft or Conduit Procedures Surgical Procedures on the Nervous System Feed
Nerve graft (includes obtaining graft), single strand, hand or foot; more than 4 cm length.
Modifiers may be applicable depending on the circumstances of the procedure. Refer to the CPT manual for guidance on modifier usage (e.g., 59 for distinct procedural service, 22 for increased procedural services, or others as deemed clinically appropriate).
Medical necessity for nerve grafting is established when a significant nerve deficit (sensory or motor) is documented, impacting the patient's quality of life and daily functions.The length of the nerve gap, which is greater than 4cm in this case, requires a nerve graft to bridge the gap and restore continuity. The choice of a single-strand nerve graft depends on the specific damage and surgeon’s preference.
The surgeon is responsible for all aspects of the procedure, including patient preparation, anesthesia, harvesting of the nerve graft, resection of the damaged nerve, nerve graft placement and suturing, and wound closure. Post-operative care and follow-up may be shared with other medical professionals depending on the complexity of the case and the patient's needs.
- Surgical Procedures on the Nervous System
- Surgical Procedures on the Extracranial Nerves, Peripheral Nerves, and Autonomic Nervous System
In simple words: The doctor replaces a damaged nerve section in your hand or foot with a healthy nerve piece longer than 4 centimeters. This repairs nerve damage from injury and restores feeling and/or movement.
This CPT code encompasses the surgical procedure of a nerve graft, specifically a single-strand nerve graft, in the hand or foot, where the harvested nerve segment exceeds 4 cm in length. The procedure involves obtaining a nerve graft (usually from the sural nerve), resecting the damaged portion of the nerve, and suturing the graft to restore nerve continuity.The surgeon ensures proper alignment and minimal tension during the anastomosis to optimize functional recovery.The procedure aims to restore sensory and/or motor function to the affected area.
Example 1: A patient presents with a severed median nerve in their hand following a motorcycle accident.The surgeon performs a nerve graft using the sural nerve from the leg, with a graft length exceeding 4cm, to restore motor and sensory function., A patient sustained a deep laceration to their foot, resulting in damage to a digital nerve.A single-strand nerve graft of over 4cm is used to bridge the gap and restore innervation., A patient with chronic compression neuropathy of the ulnar nerve at the wrist experiences significant sensory deficits in the hand. Surgical decompression with an additional single-strand nerve graft (over 4 cm) from the sural nerve is required for complete restoration of function.
* Preoperative assessment including detailed neurological examination documenting the extent of nerve damage and functional deficits.* Operative report precisely detailing the location, length, and type of nerve graft used, including the donor site.* Intraoperative photographs or videos to show the nerve repair.* Postoperative neurological examination evaluating the restoration of nerve function.* Pathology report if tissue samples are taken.
** The length of the nerve graft is a crucial factor for accurate coding.Proper documentation of the nerve involved (e.g., median, ulnar, digital) is essential.This code only includes the nerve graft itself and does not include additional procedures such as exploration, repair of other tissues, or additional nerve grafts which would require separate coding. The choice of single-strand vs. multiple-strand nerve graft depends on the nature and extent of nerve injury.
- Revenue Code: P5E (AMBULATORY PROCEDURES - OTHER)
- RVU: Information not available in provided source. Refer to CMS fee schedules for current RVU values.
- Global Days: Information not specified in the provided source.Global surgical package days will vary based on payer and specific circumstances.
- Payment Status: Active
- Modifier TC rule: The application of a Technical Component (TC) modifier will depend on whether the surgeon provided only the technical aspects or the whole procedure. If the service is part of a global package, modifiers may not be applicable.
- Fee Schedule: Historical fee schedule data is not provided in the source. This information can vary widely depending on location, payer, and year.
- Specialties:Neurosurgery, Plastic Surgery, Orthopedic Surgery, Hand Surgery
- Place of Service:Office, Ambulatory Surgical Center, Inpatient Hospital