Surgical excision of a single flexor or extensor tendon from a finger; reported once per tendon removed.

Verified May 8, 2026 · 6 sources ↓

Medicare: $431.21
Work RVU: 5.22
Global, days: 90
Region: Hand

Drawn from CMSAAPCEatonhand

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify whether the excised tendon is flexor or extensor — notes that say 'tendon removed' without this distinction are audit targets.
Identify the specific finger and zone of involvement (e.g., middle finger, zone II flexor).
Document the indication: traumatic injury, chronic tendonitis, rupture, or deformity/dysfunction with prior conservative treatment failure.
Describe the surgical approach: incision location, method of tendon isolation, extent of excision, and closure technique.
Record laterality (left vs. right hand) in both the operative note and the encounter diagnosis.
If multiple tendons are excised, document each tendon separately to support multiple units of 26180.

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 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 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 26180 covers the surgical removal of a flexor or extensor tendon from a finger — one unit per tendon excised. The procedure addresses severely damaged, ruptured, or diseased tendons that haven't responded to conservative care, including injuries from trauma, chronic tendonitis, tendon rupture, or deformity from rheumatoid arthritis. The surgeon incises, isolates, and removes the affected tendon, then closes and splints the finger.

The code carries a 90-day global period. All routine follow-up — wound checks, splint adjustments, stitch removal — is bundled through day 90. Bill modifier 24 for unrelated E&M visits and modifier 78 for unplanned return to the OR for a related complication during that window.

When multiple tendons are excised in the same operative session, report 26180 with modifier 51 for each additional tendon. Laterality matters: append LT or RT for unilateral procedures; modifier 50 applies only if the identical procedure is performed on the contralateral hand in the same session. Document whether the excised tendon is flexor or extensor — audit reviewers flag notes that omit this distinction.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU vs. total RVU

The work RVU (5.22) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (12.91) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	5.22
Practice expense RVU	6.69
Malpractice RVU	1
Total RVU	12.91
Medicare national rate	$431.21
Global period	90 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

Setting	Medicare rate (national)
Office (PFS non-facility) Procedure performed in physician's office	$431.21
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 26180 get rejected.

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

Missing laterality — payer edits reject claims without LT or RT when the payer requires them.
Operative note fails to name the specific tendon (flexor vs. extensor) or finger, leading to medical necessity denials.
Multiple units billed without distinct per-tendon documentation; payers down-code to a single unit.
Modifier 51 omitted when 26180 is reported alongside other hand procedures in the same session.
Global period conflicts — routine post-op visits billed without modifier 24 denied as already bundled in the 90-day global.

Frequently asked questions

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

01Do I bill 26180 once per operative session or once per tendon?

Once per tendon. If two tendons are excised in the same session, bill 26180 twice — the second unit with modifier 51. Document each tendon separately in the operative note.

02Which modifier applies if the patient returns to the OR during the 90-day global for a wound complication from the original excision?

Modifier 78 — unplanned return to the OR for a related procedure during the postoperative period. Modifier 79 applies only if the return procedure is unrelated to the original surgery.

03Can 26180 be billed with a same-day E&M?

Only with modifier 25 on the E&M, and only if the evaluation was a separately identifiable service beyond the decision to perform the excision. The pre-op evaluation on the day of surgery is bundled unless it was a significant, separately documented encounter.

04Is 26180 appropriate for a partial tendon excision, such as removing a portion of the sublimis?

Partial excisions can be reported under 26180, but document the extent clearly — how much of the tendon was removed and why. Payers and auditors scrutinize partial excisions for medical necessity, and incomplete documentation is the most common denial trigger.

05Does 26180 cover both flexor and extensor tendons, or are they coded separately?

26180 covers both flexor and extensor tendons — one code, one unit per tendon regardless of type. The operative note must still specify which type was excised for audit and medical necessity purposes.

06When should modifier 22 be appended to 26180?

Append modifier 22 when documented circumstances — severe scarring, prior surgery, anatomy distortion — required substantially more time and effort than the standard procedure. Attach a cover letter with operative details; payers rarely approve modifier 22 without supporting documentation.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the tendon type (flexor or extensor), specific finger, zone of involvement, surgical approach, and indication from dictation — the four data points most likely to trigger a medical necessity denial or audit flag when missing. It also flags multi-tendon cases so the coder knows to report additional units with modifier 51 rather than bundling everything into one line.

See how Mira captures CPT 26180 documentation