What this is, in plain language
A short surgery that releases the tight tunnel around a finger tendon so the finger stops catching or locking.
Why a clinician orders it
A finger that locks or catches painfully, usually after splinting or a steroid injection has failed.
Medical necessity — what insurers usually look at
Many plans expect documented conservative treatment first (splinting, steroid injection) before approving surgery. Prior authorization is commonly required for outpatient surgery.
New to this? Read what medical necessity means and how to appeal a denial.
Documentation to ask about
- ✓Conservative treatments tried and failed
- ✓Prior auth approval in writing
- ✓In-network facility and surgeon
Questions for your provider
- ?What conservative treatments does my plan require first?
- ?Has prior auth been approved in writing?
Why this code is in our seed set
Common hand surgery code; validated against the CMS Top 200 and ASSH guidance.
Validated against
- •CMS Top 200 Level I CPT Codes Ranked by Services
- •AMA CPT code 26055 descriptor
- •ASSH clinical guidance
Terms you'll see
Some services may need plan approval before they are performed.
Lower-risk care that insurers may want documented before a bigger procedure.
Trying a preferred (often lower-cost) treatment first before a different one is approved.