26055 CPT Code Reimbursement Explained

Trigger finger, also known as stenosing tenosynovitis, is a common hand condition where one of the fingers gets stuck in a bent position and pops or snaps when straightened. The ring finger and thumb are most commonly affected. CPT code 26055 is used to report surgical release procedures done to treat trigger finger.

Key takeaways:

• CPT code 26055 is for incision, synovial sheath of hand/finger for trigger finger release.
• It has a 2021 Medicare physician fee schedule of around $309 nationally.
• 26055 is for releasing the A1 pulley constricting the flexor tendon.
• It can be used for trigger finger release on multiple fingers depending on payer policies.
• 26055 has a 90 day global surgery period.

Trigger finger is caused by inflammation of the tendon sheath (stenosing tenosynovitis) which locks the flexor tendon at the level of the A1 pulley. As the condition worsens, nodules may form on the tendon causing it to catch. CPT code 26055 describes surgical release of the A1 pulley to free the locked tendon.

CPT Code 26055 Description

The full description for CPT code 26055 per the CPT Manual is:

Incision, extensor tendon sheath, wrist, and/or hand, each digit.

It is classified under the Incision Procedures on the Hand and Fingers sub-section.

What 26055 Includes

26055 includes a surgical open incision of the A1 pulley on a finger or thumb to release constriction of the flexor tendon. This is commonly referred to as a trigger finger release procedure.

It includes:

• Local anesthetic injection
• Longitudinal incision
• Identification and exposure of flexor tendon
• Release of A1 pulley
• Irrigation
• Closure with sutures

26055 does not include:

• Release of additional pulleys
• Tendon repair
• Neurolysis or nerve repair

Billing and Coding Tips

• 26055 can be reported per digit released. For example, releasing trigger finger in two digits would be billed 26055 x 2.
• Some payers do not allow separate billing for multiple digits. Check payer policies first before billing.
• 26055 is not bundled into other trigger finger release codes for separate digits. However, it should not be reported with tenolysis codes like 26145 on the same digit.
• Medicare has a national fee schedule payment of approximately $309 for 26055 in 2021. Payment will vary by location and payer.
• 26055 has a global surgery period of 90 days. This includes pre-op, surgical procedure, and post-op care.

CPT Codes for Related Procedures

Other CPT codes that may be relevant for trigger finger release:

• 26160 – Surgery on tendon sheath of hand
• 26145 – Release/reconstruction of flexor tendon sheath
• 64721 – Release of carpal tunnel
• 26060 – Incision of tendon sheath of hand

Frequently Asked Questions

Here are some common questions about CPT code 26055:

• Does 26055 require a modifier? No, a modifier is not required for 26055.
• What is the code for open trigger thumb release? 26160 is used for open surgery on thumb tendon sheath.
• Can you code 26055 and 26160 together? No, 26055 and 26160 should not be reported together.
• Can 26055 and 26145 be billed together? No, 26145 and 26055 are not coded together per CPT guidelines.

In summary, CPT code 26055 describes the surgical release procedure done to treat trigger finger. It is reported per digit released and has a 90 day global surgical period. Check payer policies for billing multiple digits.