Soft tissue repair · Hand

26170

Surgical excision of a single flexor or extensor tendon from the palm of the hand, reported once per tendon removed.

Verified May 8, 2026 · 7 sources ↓

Medicare
$391.79
Total RVUs
11.73
Global, days
90
Region
Hand
Drawn from CMSAAPCAAOS

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

  • Identify each tendon by name (e.g., flexor digitorum superficialis to long finger) and anatomic location within the palm — do not use 'palm tendon' alone.
  • State the clinical indication: trauma, infection, adhesion, failed prior repair, or planned tendon transfer preparation.
  • Document the surgical approach, incision location, and any intraoperative findings that differ from preoperative imaging.
  • Record the exact number of tendons excised; each tendon supports a separate unit of 26170.
  • Note laterality (right vs. left hand) explicitly in the operative report and on the claim.
  • If modifier 22 is used, document the specific factors that made the case substantially more complex — prior scarring, infection, or anatomic distortion.

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 25 Significant separate E/M 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 80 Assistant surgeon LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 26170 covers the open surgical removal of a flexor or extensor tendon from the palm. Indications include irreparable tendon damage from trauma or infection, adhesion-related dysfunction, and cases where tendon excision is required before reconstruction or tendon transfer. The code is reported per tendon — if two tendons are excised from the same palm in the same session, report 26170 twice with modifier 51 on the second unit.

The 90-day global period means all routine post-op palm care is bundled through day 90. Separate E/M visits during that window require modifier 24 (unrelated) or 25 (significant separate problem on the day of a minor procedure). If the decision for surgery was made at an E/M visit the day of or day before the procedure, append modifier 57 to that E/M code — 26170 carries a 90-day global, so modifier 57 applies.

Site of service matters here: HOPD and ASC facility payments differ substantially (see the Site of Service comparison table). Physician work RVUs are site-neutral, but total payment to the facility is not. Confirm place-of-service code accuracy before submission — wrong POS coding is a common underpayment trigger for hand surgery claims.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU4.79
Practice expense RVU6.02
Malpractice RVU0.92
Total RVU11.73
Medicare national rate$391.79
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
$391.79
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 26170 get rejected.

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

  • Billing multiple units without modifier 51 on the second unit, causing MUE-level denials for same-day duplicate reporting.
  • Missing or ambiguous laterality documentation when LT or RT modifier is required by the payer.
  • E/M visit billed same-day during the global period without modifier 24 or 25, triggering automatic bundling denial.
  • Operative note references 'palm tendon' without naming the specific structure, failing medical necessity review.
  • Incorrect place-of-service code mismatching the actual setting, causing facility-side payment conflicts.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01Can I bill 26170 twice if I remove two tendons from the same palm in one session?
Yes. The code is reported once per tendon excised. Bill 26170 on line one without a modifier, and 26170 again on line two with modifier 51. Each line needs the tendon identified by name in the operative note.
02Does 26170 require modifier LT or RT?
Most commercial payers and many Medicare contractors require laterality modifiers for upper-extremity procedures. Append LT or RT to every claim line for 26170 to prevent laterality-based denials. Check your specific MAC's policy, but defaulting to laterality modifiers is the safer practice.
03What is the global period for 26170?
90 days. The global package includes the day before surgery, the operative day, and all routine post-op palm care through day 90. Unrelated E/M services in that window need modifier 24; a significant separate problem on the same day as a minor procedure needs modifier 25.
04Is 26170 ever bundled with nerve decompression codes like 64721?
Per AAPC coding community discussion citing NCCI edits, 26170 is not bundled with 64721 (carpal tunnel release). If both are performed at the same encounter, they can be reported together — verify the current NCCI PTP edit table for the exact code pair before billing.
05When should modifier 22 be used with 26170?
Use modifier 22 when the excision is substantially more difficult than typical — dense post-infectious scarring, multiple prior surgeries, or significant neurovascular involvement requiring extra dissection. Document the specific factors in the operative note. Modifier 22 without supporting documentation will be stripped on audit.
06If a patient returns for tendon transfer in the 90-day global, how do I bill the new procedure?
Use modifier 58 if the tendon transfer was a planned staged procedure following the excision. Modifier 58 resets the global period clock. If the return was unplanned due to a complication related to the original excision, use modifier 78 instead. Do not use 79 — that is for an unrelated procedure in the global period.
07Does the site of service affect physician reimbursement for 26170?
Physician work RVUs are the same regardless of setting. However, the total Medicare payment differs because the non-facility practice expense RVUs are higher when the procedure is done in a non-facility setting. If 26170 is performed in an office or ASC, confirm the place-of-service code is accurate or you risk underpayment.

Sources & references

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

  1. 01CMS Physician Fee Schedule 2026
  2. 02
    cms.gov
    https://www.cms.gov/files/document/2025nccimedicarepolicymanualcompletepdf.pdf
  3. 03
    cms.gov
    https://www.cms.gov/files/document/02-chapter2-ncci-medicare-policy-manual-2025finalcleanpdf.pdf
  4. 04
    cms.gov
    https://www.cms.gov/medicare/coding-billing/national-correct-coding-initiative-ncci-edits/medicare-ncci-add-code-edits
  5. 05
    cms.gov
    https://www.cms.gov/medicare/coding-billing/national-correct-coding-initiative-ncci-edits/medicare-ncci-faq-library
  6. 06
    aapc.com
    https://www.aapc.com/codes/cpt-codes/26170
  7. 07
    aaos.org
    https://www.aaos.org/globalassets/quality-and-practice-resources/coding-and-reimbursement/resident-guide/resident-guide_modifiers.pdf

Mira AI Scribe

Mira's AI scribe captures the tendon name, palm location, laterality, surgical approach, and clinical indication directly from dictation — the details auditors check first on hand surgery operative notes. That prevents the vague 'palm tendon' documentation that triggers medical necessity denials and flags from RAC auditors reviewing 26170 claims.

See how Mira captures CPT 26170 documentation

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