Medicare Benefits Schedule - Item 46401

Operative treatment of non-union of phalanx or metacarpal of hand, including internal fixation (if performed)

Multiple Operation Rule

(Anaes.) (Assist.)

Fee: $457.45 Benefit: 75% = $343.10 85% = $388.85

(See para TN.8.190, TN.8.282 of explanatory notes to this Category)

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• Ray: From the tip of the digit to proximal metacarpal base of that digit, including phalanges and metacarpal.
• Index ray: First web in Dupuytren contracture releases is considered part of the index ray.
• Primary: Acute injury and first management of a pathology.
• Secondary: Delayed or subsequent to primary treatment, or occurring after normal expected relevant tissue healing time.
• Vascular graft: Harvesting of graft, insetting and anastomosis of both ends of graft.
• Nerve graft: Harvesting of graft, insetting and neurorrhaphy at both ends of graft.
• Tendon graft: Harvesting of graft, insetting and tensioning of graft and tendon weave/repair at both ends of graft.
• Transcarpal amputation: Includes the hand through the radiocarpal, midcarpal or carpometacarpal joints.
• Wrist joint: Includes radiocarpal, midcarpal and radioulnar joints, which are not to be billed independently. 
• Z-plasty: Raising, transfer, insetting and suturing of both components (flaps) of the Z-plasty procedure.
• Flexor tendon: A tendon on the volar aspect of the digits, hand or wrist.
  – Treatment of only two flexors can be claimed per digit/ray.
  – The two slips of flexor digitorum superficialis (FDS) inserting to the middle phalanx are not to be claimed as two tendons and are to be billed as part of the single FDS tendon.
• Nerve Trunk: A bundle of nerve fibers enclosed in a connective tissue sheath.                                    

Related Items: 44325 46300 46303 46308 46309 46312 46315 46318 46321 46322 46324 46325 46330 46333 46335 46336 46339 46340 46341 46342 46345 46348 46351 46354 46357 46360 46363 46364 46365 46367 46370 46372 46375 46378 46379 46380 46381 46384 46387 46390 46393 46394 46395 46399 46401 46408 46411 46414 46417 46420 46423 46426 46432 46434 46438 46441 46442 46444 46450 46453 46456 46464 46465 46468 46471 46474 46477 46480 46483 46486 46489 46492 46493 46495 46498 46500 46501 46502 46503 46504 46507 46510 46513 46519 46522 46525 46528 46531 46534 47024 47027 47030 47033 47042 47045 47301 47304 47307 47310 47313 47316 47319 47348 47351 47354 47357 47385 47386 48406 48409 49200 49203 49206 49209 49210 49212 49213 49215 49218 49219 49220 49221 49224 49227 49230 49233 49236 49239 50524 50528

Items 48456 includes bone grafting as a mandatory component. The nature of the bone grafting required should be consistent with items 48248-48257.

Items 46401 and 48456 are both for the operative treatment of non-union of the phalanx or metacarpal of hand. 46401 should be claimed where no bone grafting meeting the threshold of 48248-48257 has been performed.

Item 48456 is inclusive of any bone graft harvesting and insertion, arthrotomy, debridement, osteotomy, removal of hardware, or internal fixation performed on that bone. Claiming a bone grafting item (48245-48257) and item 48456 on the same occasion on the same bone is not permitted. This does not prevent MBS items that include bone grafting from being claimed for surgery undertaken on another bone on the same occasion.

Item 48456 is not inclusive of additional procedures required for the treatment of osteomyelitis. In circumstances where patients require additional surgical treatment for osteomyelitis in the hand, item 43527 can also be claimed.

Item 48456 is claimable once per bone treated.

Related Items: 46401 48248 48251 48254 48257 48456