Surgical repair or advancement of a flexor tendon in the finger or hand, performed outside zone 2 (no man's land), primary or secondary, without a free graft — billed per tendon.

Verified May 8, 2026 · 7 sources ↓

Medicare: $738.83
Total RVUs: 22.12
Global, days: 90
Region: Hand

Drawn from CMSPayerpriceMdclarityThehaugengroupAxogeninc

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Specify the exact zone of injury and repair — document that the tendon was outside zone 2 by anatomic description, not just by stating the code zone number.
Name the specific tendon(s) repaired (e.g., FDP to index finger, FPL) and the digit involved.
State whether the repair is primary (acute laceration/rupture) or secondary (delayed more than a few weeks post-injury).
Confirm no free graft was harvested or used — if a graft was required, 26350 is the wrong code.
Document the surgical approach, incision location, and repair technique (e.g., core suture method, number of strands, epitendinous suture).
Include pre-op and post-op diagnosis with supporting ICD-10 code — laceration, rupture, or attritional tear as appropriate.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 52 Reduced services 59 Distinct service 62 Co-surgeons 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 26350 covers operative repair or advancement of a single flexor tendon located outside zone 2 of the digital flexor tendon sheath — the anatomic region historically called 'no man's land' due to its notoriously poor healing outcomes. The code applies whether the repair is primary (acute) or secondary (delayed), and excludes cases requiring a free tendon graft. Bill once per tendon repaired; if multiple tendons are addressed in the same session outside zone 2, append modifier 51 to the additional units.

The zone distinction is the critical billing decision point here. Zone 2 repairs are reported with 26356–26358 depending on complexity and graft use. Zone 1 (distal to FDS insertion) and zones 3–5 (palm, wrist, forearm) all fall under 26350 when no free graft is used. Misassigning the zone is a common audit trigger, so the operative note must state explicitly where the injury and repair occurred anatomically.

The 90-day global period covers all routine post-op management from the day before surgery through day 90. Therapy-related E/M visits tied directly to the repair outcome are bundled. If you see the patient for an unrelated problem in that window, append modifier 24. An unplanned return to the OR for a related complication — such as tendon re-rupture or adhesion lysis — is modifier 78, not 79.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	6.05
Practice expense RVU	14.88
Malpractice RVU	1.19
Total RVU	22.12
Medicare national rate	$738.83
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	$738.83
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI A2) Ambulatory surgical center (freestanding)	$1,644.87

Common denial reasons

The recurring reasons claims for CPT 26350 get rejected.

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

Zone documentation absent or ambiguous — payers deny when the operative note doesn't establish that the repair occurred outside zone 2.
Unbundling with 26055 (trigger finger release) without modifier 59/XS when both are performed same-day — NCCI edits bundle these; a separately identifiable service requires a distinct procedural modifier.
Simple wound closure codes (e.g., 12001–12007) billed alongside 26350 — NCCI bundles routine wound closure into the surgical procedure.
Multiple tendon repairs reported without modifier 51, causing the additional units to process as duplicate claims.
Global period violations — E/M or procedure claims submitted within 90 days without modifiers 24, 78, or 79 when required.

Frequently asked questions

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

01What is the zone 2 distinction and why does it matter for billing?

Zone 2 runs from the proximal digital flexor tendon sheath (A1 pulley) to the FDS insertion — historically 'no man's land.' Repairs inside zone 2 use 26356, 26357, or 26358. Repairs outside zone 2 use 26350. Billing the wrong code based on a vague operative note is a consistent audit finding.

02If two flexor tendons are repaired outside zone 2 in the same digit during the same surgery, how do you bill?

Bill 26350 for the first tendon and 26350-51 for each additional tendon. The code descriptor specifies 'each tendon,' so multiple units are correct — modifier 51 signals multiple procedures in the same session.

03Can 26350 and 26055 (trigger finger release) be billed on the same day?

Yes, but only when they are genuinely distinct procedures on separate anatomic structures. Append modifier 59 or XS to 26055 to bypass the NCCI bundle edit. The operative note must document a separate indication and approach for each procedure.

04What modifier applies if the patient returns to the OR within the 90-day global for a re-rupture of the same tendon?

Use modifier 78 — unplanned return to the OR for a related procedure during the postoperative period. This reopens payment without starting a new global period. Modifier 79 is wrong here; that's for unrelated procedures.

05Is 26350 billed differently for primary versus secondary repairs?

The same CPT code covers both primary and secondary repairs without free graft. The distinction matters for documentation and occasionally for payer medical necessity review, but it does not change the code. If a free graft is required, 26350 no longer applies — you need a different code from the 26352–26358 range.

06How does the site of service affect reimbursement for 26350?

There is a significant gap between HOPD and ASC facility payments — see the Site of Service comparison on this page. The physician's professional fee also adjusts based on facility vs. non-facility setting; the non-facility RVU is higher because practice expense is shifted to the physician in an office setting, though this procedure is rarely performed in-office.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures the zone of repair, specific tendon name, digit, repair type (primary vs. secondary), graft status, and suture technique directly from dictation. This prevents the single most common denial for 26350 — missing or ambiguous zone documentation — and eliminates the audit risk of an operative note that fails to distinguish the repair site from zone 2.

See how Mira captures CPT 26350 documentation