Carpal tunnel release is one of the most performed orthopedic surgeries in the United States. Yet, many billers don’t know how to bill it correctly. Carpal tunnel release can be performed with different techniques. Each of these requires a separate billing code. One such code is CPT code 64721.
We have created this guide to help you understand what CPT code 64721 is and how you can use it properly in your claims. So, let’s start.
CPT Code 64721 – Description
CPT code 64721 is defined as:
“Neuroplasty and/or transposition; median nerve at carpal tunnel.”
As evident from the definition, CPT code 64721 is used for the treatment of carpal tunnel. It specifically represents the open surgical release of the carpal tunnel. During this procedure, the surgeon makes an incision in the palm of the hand to visualize and cut the transverse carpal ligament.
As a result, the size of the carpal tunnel increases, leading to reduced pressure on the median nerve.
An essential point to note here is that code 64721 is for open surgeries only. If the surgeon performs the release using an endoscope (a small camera inserted through a smaller incision), you must use CPT 29848 instead.
Scenarios Where CPT Code 64721 is Applicable
Let’s look at some scenarios in which CPT code 64721 can be used:
Severe Carpal Tunnel Syndrome with Failed Conservative Treatment
The most common scenario involves a patient who has lived with symptoms for months. Medical necessity usually requires documentation that the patient attempted non-surgical treatments for at least 6 weeks without significant improvement. This includes:
- Consistent use of wrist splints or braces (especially at night).
- A trial of NSAIDs or other anti-inflammatory medications.
- Corticosteroid injections into the carpal tunnel failed to provide lasting relief.
However, when the above conservative treatment options fail, the orthopedic surgeon opts for an open carpal tunnel release surgery and bills it using CPT code 64721.
Progressive Carpal Tunnel Syndrome with Nerve Damage
Immediate surgery (represented by 64721) may be justified without prolonged conservative care if there is objective evidence of nerve damage. This includes:
- Electrodiagnostic Testing: Electromyography (EMG)/ nerve conduction studies confirming moderate to severe median nerve denervation or axonal loss.
- Physical Findings: Visible atrophy (wasting) of the thenar muscles at the base of the thumb.
Applicable Modifiers for CPT Code 64721
The following modifiers are frequently used with CPT code 64721:
| Modifier | Short Description | Usage |
|---|---|---|
| 50 | Bilateral Procedure | Apply when surgery is performed on both wrists. |
| 51 | Multiple Procedures | Used when multiple procedures are performed during the same session. |
| 54 | Intraoperative Percentage | Applied when only intraoperative services are performed. |
| 55 | Postoperative Percentage | Used when reimbursement for only postoperative services is required. |
| 56 | Preoperative Percentage | This modifier is applied when billing for preoperative 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 64721 – Billing & Reimbursement Guidelines
Let’s discuss some additional points that are important to consider while filing claims for CPT code 64721:
Provide Comprehensive Documentation
To get proper reimbursement for your services and ensure that claims are processed without any hurdles, appending detailed medical and patient records is vital. A good practice is to provide the following details:
- Patient’s Clinical Presentation: Clearly state the duration of symptoms (e.g., “patient has suffered hand numbness for 6 months”). Describe the severity and how it impacts specific daily activities, like gripping, typing, or sleeping.
- Conservative Treatment History: List specific dates or durations of failed treatments.
- Surgical Details: The operative report must explicitly describe an open approach.
Understand Global Period and Bundling Rules
CPT code 64721 has a global surgical period of 90 days. This means that the reimbursement covers the preoperative visit (typically the day before or on the day of surgery), the surgery itself, and all routine postoperative care for 90 days afterward.
Additionally, codes 64721 and 29848 are bundled together. They should not be billed together for the same wrist during the same patient encounter.
Verify the Medicare Reimbursement Rate
For 2026, Medicare’s national average reimbursement rates for CPT 64721 are:
- For Facility Settings: $423.19
- For Non-Facility Settings: $482.64
However, these rates are national averages, 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
CPT code 64721 is one of the most used billing codes in orthopedics. However, its proper billing requires attention to detail and comprehensive documentation. For proper reimbursement, append appropriate modifiers where necessary. However, even after all the precautions, denials can still occur.
That’s why it is better to let professionals handle the billing. Many companies, like MediBillMD, offer expert orthopedic billing services. These companies not only know how to reduce the denial rate, but can also manage (rework or appeal) denied claims when they occur.
