Humana Commercial Clinical Policy

Humana Carpal Tunnel Syndrome Surgical Treatments Form

Effective Date

09/28/2023

Last Reviewed

NA

Original Document

  Reference



Description

Carpal tunnel syndrome (CTS) is a condition that occurs when the median nerve, which runs from the forearm into the palm of the hand, becomes compressed at the wrist. Symptoms usually start gradually, consisting of pain, weakness and/or numbness in the hand and wrist, radiating up the arm. The risk of developing carpal tunnel syndrome may be increased in those who perform repetitive work tasks. Carpal tunnel syndrome is also associated with pregnancy and conditions such as diabetes, rheumatoid arthritis, or thyroid disease.

Initial treatment generally involves resting the affected hand and wrist, avoiding activities that may worsen symptoms and immobilizing the wrist in a splint. Nonsteroidal anti-inflammatory drugs (NSAIDs) or oral steroids may be utilized for pain relief. Corticosteroid injections can also be given to alleviate the swelling and pressure on the median nerve. If conservative treatment is unsuccessful, carpal tunnel release surgery via an endoscopic or open approach may be necessary.

Surgery for CTS involves cutting the transverse carpal ligament, relieving pressure on the median nerve, which in turn reduces symptoms. The conventional surgical approach is open surgery, where the surgeon makes an incision at the base of the palm and has direct visual access to the ligament. Endoscopic surgery utilizes a small flexible tube with a camera attached and the surgeon views the ligament through the camera.

Ultrasound guided percutaneous carpal tunnel release (PCTR) is proposed as an alternative to endoscopic or open CTS surgery. PCTR procedures combine identification and guidance of carpal tunnel anatomy using ultrasound with minimal incisions. Various tools used during a PCTR to release the transverse carpal ligament include an angled blade, hook knife, needle, or surgical thread. A thread carpal tunnel release (TCTR) uses a surgical thread looped around the transverse carpal ligament to release the ligament while not damaging adjacent tissue.

For information regarding low level laser therapy, please refer to Low Level Laser and High Power Laser Therapy Medical Coverage Policy.

For information regarding a nerve connector, protector or wrap (eg, AxoGuard), please refer to Skin and Tissue Substitutes Medical Coverage Policy.

For information regarding neuromuscular ultrasound and CTS, please refer to Nerve Conduction Testing, Somatosensory and Visual Evoked Potentials, Surface Electromyography Medical Coverage Policy.

Coverage Determination

Humana members may be eligible under the Plan for carpal tunnel release surgery (endoscopic or open approach) when the following criteria are met:

  • Electrodiagnostic testing (nerve conduction studies [NCS], sometimes supplemented with needle electromyography [EMG]) confirms diagnosis of carpal tunnel syndrome

For information regarding coverage determination/ limitations for testing, please refer to Nerve Conduction Testing, Somatosensory

Carpal Tunnel Syndrome Surgical Treatments Effective Date: 09/28/2023 Revision Date: 09/28/2023 Review Date: 09/28/2023 Policy Number: HUM-0546-009

Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version.

Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.

Coverage Limitations

Humana members may NOT be eligible under the Plan for carpal tunnel release surgery (endoscopic or open approach) for any indications other than those listed above. All other indications are considered not medically necessary as defined in the member’s individual certificate. Please refer to the member’s individual certificate for the specific definition.

Carpal Tunnel Syndrome Surgical Treatments Effective Date: 09/28/2023
Revision Date: 09/28/2023
Review Date: 09/28/2023
Policy Number: HUM-0546-009 Page: 4 of 8

Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version.

Experimental/Investigational Exclusions

Humana members may NOT be eligible under the Plan for any of the following as adjunctive techniques to carpal tunnel release surgery:

  • Epineurotomy; OR
  • Flexor tenosynovectomy; OR
  • Lengthening/reconstruction of the flexor retinaculum (transverse carpal ligament); OR
  • Neurolysis1,5

These are considered experimental/investigational as they are not identified as widely used and generally accepted for the proposed uses as reported in nationally recognized peer-reviewed medical literature published in the English language.

Background

Additional information about CTS may be found from the following websites:

  • American Academy of Orthopaedic Surgeons
  • National Institute of Neurological Disorders and Stroke
  • National Library of Medicine
Medical Alternatives

Physician consultation is advised to make an informed decision based on an individual’s health needs.

Any CPT, HCPCS or ICD codes listed on this medical coverage policy are for informational purposes only. Do not rely on the accuracy and inclusion of specific

Provider Claims Codes Carpal Tunnel Syndrome Surgical Treatments

Effective Date: 09/28/2023
Revision Date: 09/28/2023
Review Date: 09/28/2023
Policy Number: HUM-0546-009 Page: 5 of 8

Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version.

Inclusion of a code does not guarantee coverage and or reimbursement for a service or procedure.

Provider Claims Codes Carpal Tunnel Syndrome Surgical Treatments

Effective Date: 09/28/2023
Revision Date: 09/28/2023
Review Date: 09/28/2023
Policy Number: HUM-0546-009 Page: 6 of 8

CPT® Code(s)

  • 29848 - Endoscopy, wrist, surgical, with release of transverse carpal ligament. Not Covered if used to report any procedure outlined in Coverage Limitations section
  • 64721 - Neuroplasty and/or transposition; median nerve at carpal tunnel. Not Covered if used to report any procedure outlined in Coverage Limitations section
  • 64999 - Unlisted procedure, nervous system. Not Covered if used to report any procedure outlined in Coverage Limitations section
  • 76942 - Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation. Not Covered if used to report any procedure outlined in Coverage Limitations section
  • CPT® Category Ill Code(s) - Description not provided. Comments not provided.

HCPCS Code(s)

No code(s) identified

  1. American Academy of Orthopaedic Surgeons (AAOS). Management of carpal tunnel syndrome evidence-based clinical practice guideline. https://www.aaos.org. Published February 29, 2016. Accessed September 14, 2023.

References

Carpal Tunnel Syndrome Surgical Treatments Effective Date: 09/28/2023 Revision Date: 09/28/2023 Review Date: 09/28/2023 Policy Number: HUM-0546-009 Page: 7 of 8

Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version.

Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.

  1. Hayes, Inc. Medical Technology Directory. Comparative effectiveness review of endoscopic surgery for carpal tunnel release: a review of reviews. https://evidence.hayesinc.com. Published November 30, 2018. Updated April 6, 2023. Accessed September 5, 2023.
  2. Hayes, Inc. Medical Technology Directory. Ultrasound guided percutaneous carpal tunnel release for the treatment of carpal tunnel syndrome. https://evidence.hayesinc.com. Published January 17, 2019. Updated December 31, 2021. Accessed September 5, 2023.
  3. MCG Health. Carpal tunnel decompression procedures: open and endoscopic. 27th edition. https://www.mcg.com. Accessed July 27, 2023.
  4. MCG Health. Carpal tunnel syndrome referral management. 27th edition. https://www.mcg.com. Accessed July 27, 2023.
  5. MCG Health. Electromyography, nerve conduction studies. 27th edition. https://www.mcg.com. Accessed July 27, 2023.
  6. UpToDate, Inc. Carpal tunnel syndrome: clinical manifestations and diagnosis. https://www.uptodate.com. Updated August 2023. Accessed September 5, 2023.
  7. UpToDate, Inc. Carpal tunnel syndrome: pathophysiology and risk factors. https://www.uptodate.com. Updated August 2023. Accessed September 5, 2023.
  8. UpToDate, Inc. Carpal tunnel syndrome: treatment and prognosis. https://www.uptodate.com. Updated August 2023. Accessed September 5, 2023.
  9. UpToDate, Inc. Neurologic disorders complicating pregnancy. https://www.uptodate.com. Updated August 2023. Accessed September 5, 2023.
  10. UpToDate, Inc. Neurologic manifestations of hypothyroidism. https://www.uptodate.com. Updated August 2023. Accessed September 5, 2023.

Carpal Tunnel Syndrome Surgical Treatments Effective Date: 09/28/2023
Revision Date: 09/28/2023
Review Date: 09/28/2023
Policy Number: HUM-0546-009 Page: 8 of 8

Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version. Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.

  1. UpToDate, Inc. Neurologic manifestations of rheumatoid arthritis. https://www.uptodate.com. Updated August 2023. Accessed September 5, 2023.
  2. UpToDate, Inc. Neuromuscular manifestations of systemic sclerosis (scleroderma). https://www.uptodate.com. Updated August 2023. Accessed September 5, 2023.
  3. UpToDate, Inc. Overview of the musculoskeletal complications in diabetes mellitus. https://www.uptodate.com. Updated August 2023. Accessed September 5, 2023.
  4. UpToDate, Inc. Surgery for carpal tunnel syndrome.https://www.uptodate.com. Updated August 29, 2023. Accessed September 5, 2023.