Sometimes billing a CPT code isn’t hard. What’s hard is remembering the prerequisites for that code and other factors that affect the usage. CPT code 29848 is one such code. The definition and usage seem simple enough. However, applying it in real-world scenarios can be challenging.
That’s why we have created this guide on what 29848 is and how you can use it effectively in your claim. So, let’s start.
CPT Code 29848 – Description
CPT code 29848 is defined as:
“Endoscopy, wrist, surgical, with release of transverse carpal ligament.”
In simple words, 29848 is used to bill a minimally invasive surgical procedure, called “endoscopic carpal tunnel release (ECTR)”. The surgery is performed to relieve pressure on the median nerve. Let’s briefly discuss what exactly happens during the procedure.
Like most surgeries, the procedure starts with the administration of anesthesia. Once the area is numb (local anesthesia) or the patient is unconscious (general anesthesia), the surgeon makes a small incision (usually at the wrist or palm) and inserts an endoscope, which is a thin tube with a camera attached.
The endoscope allows the physician to visualize the transverse carpal ligament from the inside. Then, using specialized instruments inserted through the same or a second small portal, the surgeon cuts (releases) the ligament, thereby increasing the size of the carpal tunnel and alleviating the compression on the nerve.
A Scenario Where CPT Code 29848 is Applicable
To better understand why and when CPT code 29848 is used, let’s look at a real-world scenario.
Carpel Tunnel Syndrome
Suppose a patient comes to an orthopedic practice. The patient shares with the physician that he has been feeling constant numbness in the thumb, index, and middle fingers. During the examination, the patient states that he tried another treatment with another physician, who prescribed 6 weeks of hand/wrist immobilization (braces). However, nothing helped.
The physician orders a nerve conduction study (NCS) and, after interpreting the results, diagnoses carpal tunnel syndrome. Given the treatment history, he suggests surgery as the permanent treatment option. So, he performs a simple endoscopic carpal tunnel release (ECTR). In this scenario, the billing team can use CPT code 29848 to bill the surgical procedure.
Applicable Modifiers for CPT Code 29848
The following modifiers are commonly used with CPT code 29848:
| Modifier | Short Description | Usage |
|---|---|---|
| 50 | Bilateral procedure | Apply to CPT 29848 when surgery is performed on both wrists. |
| 51 | Multiple Procedures | Used when multiple procedures are performed during the same operative session. |
| 54 | Intraoperative Percentage | Applied when only intraoperative services are performed. |
| 55 | Postoperative Percentage | Modifier 55 is used when the provider seeks reimbursement for only postoperative services. |
| 56 | Preoperative Percentage | This modifier is applied when billing for pre-operative services. |
| LT | Left Side | Used when the procedure is performed on the left wrist. |
| RT | Right Side | Used when the procedure is performed on the right wrist. |
CPT Code 29848 – Billing & Reimbursement Guidelines
Below are some essential billing guidelines that you must follow while filing claims for CPT code 29848:
Check for the Clinical Indications
Every prominent insurance payer has slightly different criteria for considering the medical necessity and validity of an endoscopic carpal tunnel release. However, in general, the following requirements should be met:
- Confirmed Diagnosis: Clinical evaluation must confirm the diagnosis of carpal tunnel syndrome through history, physical exam, and/or confirmatory electrodiagnostic testing.
- Symptom Severity: There must be persistent pain, sensory loss, or paresthesia (tingling) in the median nerve distribution.
- Failed Conservative Treatment: The symptoms must be refractory to at least one conservative treatment, such as:
- Over-the-counter NSAIDs.
- 6-8 weeks of hand/wrist immobilization (brace or splint).
- Local steroid injections.
Provide Detailed Documentation
To support the medical necessity and proper coding of CPT code 29848, your documentation must be impeccable. Ensure the following elements are present in the patient’s medical record:
- Clinical Evaluation: Detailed notes confirming the diagnosis of carpal tunnel syndrome.
- Physical Exam: Positive Phalen’s test, Tinel’s sign, or Durkan’s compression test findings.
- Diagnostic Testing: Electrodiagnostic testing results (EMG/NCS) if applicable or required by the specific payer.
- Conservative Treatment History: Clear documentation of failed conservative treatments, including dates and duration of splinting or dates of steroid injections.
- Operative Report: A detailed narrative of the procedure, especially mentioning the endoscopic approach, visualization of the transverse carpal ligament, and its complete release.
- Surgical Times: Start and end times for the procedure.
Be Wary of Global Period and Bundling
CPT code 29848 has a 90-day global period. This means that the reimbursement for the surgical code includes the preoperative visit (usually the day before or day of surgery), the intraoperative services, and standard postoperative care for 90 days following the surgery.
Another point to note is that you cannot bill code 29848 and CPT code 64721 (open carpel tunnel release) for the same wrist at the same patient encounter. Both of these services are bundled, and only one can be used at a time.
Verify the Medicare Reimbursement Rate
For 2026, Medicare’s national average reimbursement rates for CPT 29848 are:
- For Facility Settings: $485.65
- For Non-Facility Settings: $485.65
However, these rates are the national average, and the actual reimbursement amount varies for each Medicare Administrative Contractor (MAC) locality. You can check the rate for your MAC via the PFS Lookup Tool.
Wrapping Up
Let’s wrap up this guide by revisiting the essential points that we discussed.
- CPT code 29848 is an orthopedic billing code. It is used to bill a minimally invasive endoscopic carpal tunnel release.
- You cannot bill 29848 with CPT code 64721.
- For proper reimbursement, you must append appropriate modifiers and detailed documentation to your claims.
Hopefully, with the help of this guide, you can successfully file claims for 29848. However, if you are facing repeated denials or bottlenecks in your revenue cycle, consider employing expert orthopedic billing services from specialized billing companies like MediBillMD.
