CPT Code 64721

(2022) CPT Code 64721 Description, Guidelines, Reimbursement, Modifiers & Example

CPT code 64721 bills for the service when the Physician performs Neuroplastic and/or transposition of the median nerve at the carpal tunnel. The Physician conducts Surgery to relieve pain and pressure on the median (carpal tunnel) nerve by freeing tissue surrounding the nerve.

CPT Code 64721 Description

The following are the reasons when Physician performs neuroplastic procedures:

  • Pain is not relieved by medication.
  • Compression of median nerves causes pain and weakens the muscles
  • Tingling, pain, numbness, weakness, and difficulty in movement of hands

The median or ulnar nerve is transposed or decompressed by the Physician to relieve pain and restore the feelings of the hand.

TIP: If billing for cubital tunnel release related to the ulnar nerve, report CPT 64718 or CPT 64719. You can find the billing guide here.

The Physician makes the horizontal incision to locate the nerve in the wrist at the metacarpal joints to release the pressure on the nerve and relieve the pain.

CPT code 64721 reports when the Physician performs to decompress the median nerve inside the carpal tunnel to free the nerve.

The sutured will be applied in layers to the incision site after freeing the nerve, and the Physician will provide the necessary care to release the pressure on the carpal tunnel. While CPT code 64719 bills when the Physician performs a procedure to free the ulnar nerve.

64721 cpt code

CPT Code 64721 Billing Guidelines

Documentation should support the medical necessity of service. It reflects that service is medically necessary and appropriate. 

The following are the most used payable dx codes for CPT code 64721:

M25.531, M25.532, M79.631, M79.632, G56.01, G56.02, etc.

If a tissue expander is incorporated other than the breast, subsequent expansion (CPT 11960) does not report with CPT 64721. CPT 11960 includes in CPT 64721, and unless it performs on different anatomical sites, it is allowed to bill together with the appropriate modifier.

CPT 64721 includes External neurolysis and transposition to repair or restore nerve, Neuroplasty with nerve wrapping, Surgical decompression/freeing nerve from scar tissue

If the CPT code 69721 Facial nerve decompression performs in combination with CPT 64721, it is separately reportable without any modifier.

If Percutaneous neurolysis (62263-62264, 62280-62282)  performs in conjunction with CPT 64721, these CPTs are separately reportable with CPT 64721 without appending any modifier.

If Casts and Strapping apply in addition to CPT 64721, casts and strapping will be reported separately in the CPT book surgery section, Under the Musculoskeletal system.

For Neuroplasty and or transposition of the ulnar nerve, see 64719. For an arthroscopic procedure with the transverse carpal ligament release, see 29848. Do not report 64721 with 11960.

Suppose the E/M visit is for post-operative care of a prior surgical procedure if the patient sees for an unrelated condition on the exact procedure date. In that case, it is not appropriate to report the E/M code with 64721 separately during the global period time. While modifier 25 will be applicable with CPT code 64721. 

CPT Code 64721 Modifiers

The following are the list modifiers applicable with CPT code 64721:   

22, 23, 47, 51, 52, 53, 54, 55, 56, 58, 59, 62, 63, 76, 77, 78, 79, 80, 81 82, 99, , AS, CC, CR, ET, EY, GA, GC, GK, GR, GU, GY, GZ, KX, Q5, Q6, QJ, SG, TC, XR, XP, XU, XS, AI, AQ, AR.     

Modifier 47 is applicable 64721 CPT code when the surgeon administers general or regional anesthesia to the patient. It is not appropriate to report modifier 47 with anesthesia procedures.  

Modifier 76 is appropriate with CPT 64721 when a similar service performs by the Same Physician on the same service date.   

Modifier 54 is applicable with CPT code 64721 when the Physician provides surgical care only. In contrast, Modifiers 55 and 56 attach to CPT 64721 when the Physician performs post-management and pre-operative care only.   

Modifier 77 is applicable with CPT 64721 when a similar service performs by a different Physician on the same service date.   

Modifier 59 is applicable with CPT code 64721  when a Distinct service performs by the Physician and bundled with another procedure on the same date.     

Modifier X {E, P, S, U} is applicable instead of Modifier 59 with CPT 64721   when service bills to Medicare insurance. It divides the modifier into four parts for further specification of the procedure.   

Modifier 53 will be reported with CPT 64721 if an unsuccessful attempt for Neuroplastic and or transposition of the median nerve at the carpal tunnel due to unavoidable circumstances like allergic reactions to the substance.   

Modifier 22 applies to CPT 64721 when services perform longer than usual and take extra resources during the procedure.   

Modifier 23 is applicable with CPT 64721 when general or local anesthesia administers by the Physician and routinely does not require during the procedure.   

Modifier 52 applies when the Physician does not complete the Neuroplastic and or transposition of the median nerve at the carpal tunnel service and terminates due to unavoidable circumstances.   

If physicians believe that Medicare will deny such service, reporting with a GA modifier is appropriate. The beneficiary must sign an Advance Beneficiary Notification (ABN), and 64721 CPT code must apply the GA modifier to that service.

CPT Code 64721 Reimbursement

A maximum of one unit can be a bill on the same service date of CPT 64721. In contrast, the Two units allow documentation supporting the service’s medical necessity. 

The cost and RUVS of CPT 64721 are $491.23 and 14.19474 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 64721 are $501.39 and 14.48849 when performed in the non-facility. 

CPT Code 64721 Examples

The following are the examples of CPT code 64721 when performed:

Example 1

A 35-year-old male presents to the emergency department with status post right wrist fracture about six months ago and now with constant pain in the right wrist from 1 to 3 months. Pain is 10 out of 10 in severity. 

The patient did take Tylenol for pain relief, but it gives pain relief for 1 to 2 hours. He has also pinched and numbness in his right hand and cannot hold anything for a longer time. 

Physical exam revealed swelling in the right upper limb with severe pain, the median nerve decompressed, and no medication contributed to the relief of the pain. The Physician has completed the review of 10 organ systems. Overall, the patient seems well and has no dietary issues. 

Physicians ordered CT, MRI, and Doppler Venous ultrasound to diagnose the problem triggering the pain in the right upper limb. Diagnostic tests revealed that the patient has carpal tunnel syndrome. 

The Physician set an orthopedic appointment for the patient, and he suggested Neuroplastic and or transposition on the median nerve at the carpal tunnel. The Physician means the patient has Carpel tunnel release surgery. Otherwise, symptoms will get worse as time passes on.

Example 2

A 39-year-old female presented to the emergency department with no past medical and family history and is now with tingling, numbness, and pinching in both hands for 15 days. Pain is getting sware with the movement of hands and unable to hold anything.

 The patient did receive a pain injection for pain relief, but it was adequate for a limited time—the 10 points of review of systems have been completed and reviewed. Physical exams revealed that the patient has erythema of both upper extremities, swelling, and pain with applying pressure. 

The Physician ordered diagnostic tests like LABS, Radiology test CT, MRI, and US doppler of both upper extremities o confirm the patient’s condition. The studies revealed that the patient has compressed transverse carpal ligaments and needs a decompression procedure to release that nerve for pain relief. 

The Physician set an orthopedic appointment for the patient, and he suggested Neuroplastic and or transposition of the median nerve on the carpal tunnel.

Example 3

A 53-year-old female presents to the emergency department with no past medical and family history and is now with pain in the wrist for three days. Pain is getting sware with the movement of hands and unable to hold anything.

 The patient did receive a pain injection for pain relief, but it was adequate for a limited time. The 10 points of review of systems have been completed and reviewed. Physical exams revealed that the patient has erythema of both upper extremities, swelling, and pain with applying pressure. 

The Physician ordered diagnostic tests like LABS, Radiology test CT, MRI, and US doppler of both upper extremities o confirm the patient’s condition. The studies revealed that the patient has compressed transverse carpal ligaments and needs a decompression procedure to release that nerve for pain relief. 

The Physician set an orthopedic appointment for the patient, and he suggested Neuroplastic and or transposition of the median nerve on the carpal tunnel.

Example 4

A 57-year-old female presents to the emergency department with pain in the right wrist for two days. The patient did not take any medication for pain.

The patient did receive a pain injection for pain relief, but it was adequate for a limited time. The 10 points of review of systems have been completed and reviewed. Physical exams revealed that the patient has erythema of both upper extremities, swelling, and pain with applying pressure. 

The Physician ordered diagnostic tests like LABS, Radiology test CT, MRI, and US doppler of both upper extremities o confirm the patient’s condition. The studies revealed that the patient has compressed transverse carpal ligaments and needs a decompression procedure to release that nerve for pain relief. 

The Physician set an orthopedic appointment for the patient, and he suggested Neuroplastic and or transposition of the median nerve on the carpal tunnel.

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