Nerve Grafting and Reconstruction: Selected Indications (CPB 0416, reviewed 2026-09-28)
Effective date
Not stated in the notice
Identified
Oct 4, 2026
Summary
Nerve allograft (Avance) is considered medically necessary for repair of short-to-medium sensory nerve gaps of 30 mm or less in the upper extremity. CPT 64912 and 64913 are covered when those selection criteria are met. Sural, cavernous and genitofemoral nerve grafts during radical retropubic prostatectomy, nerve allograft for motor nerve repair, long gaps over 30 mm, large-diameter nerves, lower extremity reconstruction, collagen conduits, and synthetic or xenograft nerve grafts and wraps for all indications are considered experimental, investigational or unproven. Cross-palm nerve grafting, intra-operative electrical stimulation, nerve wrapping for compression neuropathy, phrenic nerve reconstruction for diaphragmatic paralysis (other than prompt repair of acute phrenic nerve transection due to trauma or surgery), and vascularized nerve grafts for a nerve gap are also considered experimental, investigational or unproven.
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01Billing team: Before billing CPT 64912 or 64913 for nerve allograft, confirm the repair is a sensory nerve gap of 30 mm or less in the upper extremity.
02Do not bill CPT 0882T, 0883T or 64911 for the indications listed as not covered, including intra-operative electrical stimulation of peripheral nerve in the upper extremity.
03Do not bill nerve wraps or conduits as separate services, because they are considered integral to the surgical procedure and not separately reimbursed.
04HCPCS C1763, C9352, C9353, C9355 and C9361 are not covered for the indications listed, and ICD-10 codes G57.00 through G58.9 (compression neuropathy) and J98.6 (diaphragmatic paralysis) are not covered for those indications.
Summaries are AI-assisted. Always confirm against the original payer notice.
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