Medicare Benefits Schedule - Note TN.8.185

• Procedures 46335, 49339, 46340 and 46341, if performed, include tenoplasty, tenolysis, tendon nodules removal, and neurolysis.
• Item 46339, for flexor tendon synovectomy, includes carpal tunnel release, if performed.
• Items 46340 and 46341 may be for either flexor or extensor tendon synovectomy.
  • Where the procedure is for flexor tendon synovectomy, these items include carpal tunnel release, if performed.
  • Where the procedure is for extensor tendon synovectomy only, carpal tunnel release is not included and may be separately clamed under item 39331 if performed.
• Item 46335, for extensor tendon synovectomy, does not include carpal tunnel release, if performed.
• The item claimed should be chosen based on the tendons being treated rather than the site of the incision.

Related Items: 46335 46339 46340 46341

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Multiple Operation Rule

Synovectomy of digital extensor tendons of hand, distal to wrist, for diagnosed inflammatory arthritis, including any of the following (if performed):

(a) reconstruction of extensor retinaculum;

(b) removal of tendon nodules;

(c) tenolysis;

(d) tenoplasty;

other than a service associated with:

(e) a service to which item 39330 applies; or

(f) a service to which item 30023 applies that is performed at the same site

Applicable once per hand per occasion on which the service is performed

(Anaes.) (Assist.)

Fee: $513.15 Benefit: 75% = $384.90 85% = $436.20

(See para TN.8.184, TN.8.185, TN.8.190, TN.8.283 of explanatory notes to this Category)

Multiple Operation Rule

Synovectomy of digital flexor tendons at wrist level, for diagnosed inflammatory arthritis, including either or both of the following (if performed):

(a) tenolysis;

(b) release of median nerve and carpal tunnel;

other than a service associated with:

(c) a service to which item 39330 or 39331 applies; or

(d) a service to which item 30023 applies that is performed at the same site

Applicable once per wrist per occasion on which the service is performed (H)

(Anaes.) (Assist.)

Fee: $513.15 Benefit: 75% = $384.90

(See para TN.8.185, TN.8.190, TN.8.283 of explanatory notes to this Category)

Multiple Operation Rule

Synovectomy of wrist flexor or extensor tendons of hand or wrist, for diagnosed inflammatory tenosynovitis, including any of the following (if performed):

(a) reconstruction of flexor or extensor retinaculum;

(b) removal of tendon nodules;

(c) tenolysis;

(d) tenoplasty;

other than a service associated with:

(e) a service to which item 39330 applies; or

(f) if this service is performed on the wrist flexor tendons—a service to which item 39331 applies; or

(g) a service to which item 30023 applies that is performed at the same site

—one or more compartments per limb (H)

(Anaes.) (Assist.)

Fee: $436.20 Benefit: 75% = $327.15

(See para TN.8.184, TN.8.185, TN.8.190, TN.8.283 of explanatory notes to this Category)

Multiple Operation Rule

Synovectomy of wrist flexor or extensor tendons of hand or wrist, for non-inflammatory tenosynovitis or post traumatic synovitis, including any of the following (if performed):

(a) reconstruction of flexor or extensor retinaculum;

(b) removal of tendon nodules;

(c) tenolysis;

(d) tenoplasty;

other than a service associated with:

(e) a service to which item 39330 applies; or

(f) if this service is performed on the wrist flexor tendons—a service to which item 39331 applies; or

(g) a service to which item 30023 applies that is performed at the same site

—one or more compartments per limb (H)

(Anaes.) (Assist.)

Fee: $279.75 Benefit: 75% = $209.85

(See para TN.8.185, TN.8.190, TN.8.283 of explanatory notes to this Category)