Medicare Benefits Schedule - Note TN.8.204

• An adjacent tendon transfer is defined as a side to side repair or transfer of an adjacent tendon to the tendon being reconstructed and covered under 49724.
• When a tendon is harvested from a site separate to the reconstructed tendon or moved to the contralateral side of the foot then item 49736 can be combined.

Related Items: 49724 49727 49728 49736 49803 49806 49809 49812 49814

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Multiple Operation Rule

Reconstruction of major tendon of ankle, by any method, including any of the following (if performed):

(a) synovial biopsy;

(b) synovectomy;

(c) adjacent tendon transfer;

(d) turn down flaps;

other than a service associated with a service to which item 49718 applies (H)

(Anaes.) (Assist.)

Fee: $725.50 Benefit: 75% = $544.15

(See para TN.8.199, TN.8.204 of explanatory notes to this Category)

Multiple Operation Rule

Lengthening of major tendon of ankle, including either or both of the following (if performed):

(a) synovial biopsy;

(b) synovectomy

(H)

(Anaes.) (Assist.)

Fee: $310.75 Benefit: 75% = $233.10

(See para TN.8.199, TN.8.204 of explanatory notes to this Category)

Multiple Operation Rule

Lengthening of Achilles’ tendon, by any method, with gastro-soleus lengthening for the correction of equinous deformity, including either or both of the following (if performed):

(a) synovial biopsy;

(b) synovectomy;

other than a service associated with a service to which item 49727 applies (H)

(Anaes.) (Assist.)

Fee: $621.60 Benefit: 75% = $466.20

(See para TN.8.199, TN.8.204 of explanatory notes to this Category)

Multiple Operation Rule

Reconstruction of major tendon of ankle, by any method, including:

(a) osteotomy of hindfoot, with internal fixation; and

(b) lengthening of major tendon of ankle; and

(c) any of the following (if performed):

(i) synovial biopsy;

(ii) synovectomy;

(iii) adjacent tendon transfer;

(iv) turn down flaps;

other than a service associated with a service to which item 49718 applies (H)

(Anaes.) (Assist.)

Fee: $1,088.20 Benefit: 75% = $816.15

(See para TN.8.200, TN.8.204 of explanatory notes to this Category)

Multiple Operation Rule

Transfer of major tendon of foot and ankle, including:

(a) split or whole transfer to contralateral side of foot; and

(b) passage of posterior or anterior tendon to, or through, interosseous membrane; and

(c) any of the following (if performed):

(i) synovial biopsy;

(ii) synovectomy;

(iii) tendon lengthening;

(iv) insetting of tendon

(H)

(Anaes.) (Assist.)

Fee: $725.50 Benefit: 75% = $544.15

(See para TN.8.199, TN.8.204 of explanatory notes to this Category)

Multiple Operation Rule

Secondary repair of flexor or extensor tendon of foot, including either or both of the following (if performed):

(a) synovial biopsy;

(b) synovectomy;

—one toe

(Anaes.) (Assist.)

Fee: $186.55 Benefit: 75% = $139.95 85% = $158.60

(See para TN.8.199, TN.8.204 of explanatory notes to this Category)

Multiple Operation Rule

Subcutaneous tenotomy of foot, by small percutaneous incisions—one or more tendons

(Anaes.)

Fee: $145.05 Benefit: 75% = $108.80 85% = $123.30

(See para TN.8.199, TN.8.204 of explanatory notes to this Category)

Multiple Operation Rule

Open tenotomy or lengthening of foot, by open incision, with or without tenoplasty, including either or both of the following (if performed):

(a) synovial biopsy;

(b) synovectomy;

—one toe

(Anaes.) (Assist.)

Fee: $238.30 Benefit: 75% = $178.75 85% = $202.60

(See para TN.8.199, TN.8.204, TN.8.223 of explanatory notes to this Category)

Multiple Operation Rule

Advancement of tendon or ligament transfer of foot, including:

(a) side to side transfer, harvesting and transfer for ligament or minor foot tendon reconstruction; and

(b) either or both of the following (if performed):

(i) synovial biopsy;

(ii) synovectomy;

—one major tendon or toe (H)

(Anaes.) (Assist.)

Fee: $476.55 Benefit: 75% = $357.45

(See para TN.8.199, TN.8.201, TN.8.204, TN.8.223 of explanatory notes to this Category)