Soft tissue repair · Hand

26145

Radical synovectomy of a flexor tendon sheath in the palm or finger — billed once per tendon treated.

Verified May 8, 2026 · 6 sources ↓

Medicare
$486.99
Total RVUs
14.58
Global, days
90
Region
Hand
Drawn from CMSAAPCTdiEmednyAAOS

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 6 cited references ↓

  • Specify which tendon(s) were treated and the corresponding finger or palm location — document each tendon separately if multiple units are billed.
  • Describe the pathological synovium found intraoperatively (e.g., hypertrophied, inflamed, or fibrotic tissue) to support 'radical' classification and distinguish from simple debridement.
  • Name the surgical approach and confirm open access to the tendon sheath — notes that say only 'tenosynovectomy performed' without detail are audit red flags.
  • If billing 26145 with 26440 on the same session, document that the tenolysis was performed on a distinct tendon or site to support modifier 59 unbundling.
  • Record the preoperative diagnosis driving the procedure (e.g., rheumatoid tenosynovitis, post-traumatic scarring) and how it correlates with intraoperative findings.
  • For multiple tendons, identify each tendon individually in the operative report body — not just in the header — to substantiate multiple units billed with finger-level modifiers.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 24 Unrelated E/M during global 51 Multiple procedures 52 Reduced services 57 Decision for surgery 58 Staged or related 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 26145 covers radical tenosynovectomy of a flexor tendon sheath in the palm and/or finger. The surgeon excises pathological synovial tissue from the tendon sheath — not a simple debridement, but a thorough removal requiring documentation of diseased or inflamed synovium. The code is reported per tendon, so multiple affected tendons in the same operative session each warrant a separate unit with appropriate finger-level modifiers (F1–F9) and modifier 51 on subsequent procedures.

This procedure is most common in patients with rheumatoid arthritis, inflammatory tenosynovitis, or post-traumatic scarring that restricts flexor tendon gliding. The distinction between a radical tenosynovectomy (26145) and simple tendon sheath excision or tenolysis (26440) matters for both reimbursement and audit defense — operative notes must describe the extent of synovial resection clearly.

Not all payers treat 26145 as a stand-alone payable when billed with 26440 on the same tendon. Per NCCI, 26440 is a component of 26145, but modifier 59 can unbundle the pair when the tenolysis was performed on a distinct tendon or at a separate site — and the operative note must explicitly support that distinction. The 90-day global period applies; any related returns to the OR within that window require modifier 78.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU6.33
Practice expense RVU7.04
Malpractice RVU1.21
Total RVU14.58
Medicare national rate$486.99
Global period90 days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

SettingMedicare rate (national)
Office (PFS non-facility)
Procedure performed in physician's office
$486.99
HOPD (APC 5112)
Hospital outpatient department
$1,642.82
ASC (PI A2)
Ambulatory surgical center (freestanding)
$872.87

Common denial reasons

The recurring reasons claims for CPT 26145 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

  • Multiple units billed without finger-level modifiers (F1–F9) or without identifying each tendon individually in the operative note.
  • 26440 (tenolysis) bundled with 26145 on the same tendon without modifier 59 and without documentation of a distinct service.
  • Operative note lacks evidence of 'radical' extent — payers deny when documentation reads like routine tendon sheath irrigation rather than synovial excision.
  • Modifier 51 missing on secondary tendon units billed in the same session, triggering claim edits or duplicate-service denials.
  • Related E/M billed in the 90-day global period without modifier 24, resulting in automatic denial as included post-op care.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01How do I bill 26145 when the surgeon treated three flexor tendons in the same hand during one session?
Report 26145 three times — once per tendon. Use finger-level modifiers (e.g., F7, F8, F9) to identify each digit, append modifier 51 to the second and third units, and ensure the operative note names each tendon individually. Do not bill multiple units on a single line without distinguishing the tendons.
02Can 26145 and 26440 be billed together?
Only when they were performed on distinct tendons or sites. NCCI bundles 26440 into 26145 when both apply to the same tendon. If the tenolysis was on a separate tendon, append modifier 59 to 26440 and document the distinct service clearly in the operative report — site, tendon name, and clinical rationale.
03What makes this a 'radical' tenosynovectomy versus a routine one?
The operative note must describe thorough excision of pathological synovial tissue from the tendon sheath — not irrigation, debridement, or partial release. Documenting hypertrophied, inflamed, or fibrotic synovium and its removal is what sustains the code under audit. If the note only mentions 'cleaning out' the sheath, expect downcoding.
04Does the 90-day global period affect how I bill a return to the OR?
Yes. A related return within 90 days requires modifier 78 on the return procedure — no separate E/M for that visit. An unrelated procedure in the same window gets modifier 79. A staged, planned return uses modifier 58 and resets the global clock. Never use 78 and 79 interchangeably — they have distinct definitions and payment consequences.
05Do I need a separate diagnosis code documenting pathological synovium to justify 26145?
The diagnosis code must reflect the clinical condition driving the procedure — inflammatory tenosynovitis, rheumatoid arthritis, post-traumatic synovitis, etc. A nonspecific code like 'finger pain' alone won't support medical necessity for a radical synovectomy. Payers cross-reference the diagnosis with operative findings, so alignment between the claim and the note is essential.
06When should modifier 22 be used with 26145?
Use modifier 22 when the procedure required substantially more work than typical — for example, severe adhesions, prior surgery complicating dissection, or unusually extensive synovial involvement across multiple compartments. Document the specific factors that increased complexity and estimate additional time or effort in the operative note. Without that documentation, payers will reject the modifier 22 upcharge.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

  1. 01CMS Physician Fee Schedule 2026
  2. 02
    aapc.com
    https://www.aapc.com/codes/cpt-codes/26145
  3. 03
    tdi.texas.gov
    https://www.tdi.texas.gov/medcases/medfee12/m4121358.pdf
  4. 04
    emedny.org
    https://www.emedny.org/providermanuals/physician/pdfs/physician%20procedure%20codes%20sect5.pdf
  5. 05
    aaos.org
    https://www.aaos.org/globalassets/quality-and-practice-resources/coding-and-reimbursement/resident-guide/resident-guide_modifiers.pdf
  6. 06
    eatonhand.com
    https://www.eatonhand.com/coding/n26145.htm

Mira AI Scribe

Mira's AI scribe captures the tendon-level detail that 26145 audits demand: which specific tendon was treated, the finger or palm location, the intraoperative description of pathological synovium, and the extent of sheath resection. It flags when an operative note uses generic language like 'tenosynovectomy performed' without specifying the degree of resection — the top reason payers reclassify 26145 to a lower-valued code or deny outright. When multiple tendons are documented, the scribe prompts finger-modifier assignment for each unit before the claim is built.

See how Mira captures CPT 26145 documentation

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