Secondary flexor tendon repair or advancement outside zone 2 (no man's land), performed with a free graft; includes harvesting the graft at the time of repair.

Verified May 8, 2026 · 7 sources ↓

Medicare: $804.63
Total RVUs: 24.09
Global, days: 90
Region: Hand

Drawn from CMSFastrvuAAPCMdclarityEatonhand

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 affected finger, tendon (FDP vs. FDS), and anatomic zone — document explicitly that the repair is outside zone 2.
Confirm this is a secondary procedure: note the date of original injury or prior surgery and explain why primary repair was not performed or failed.
Identify the graft donor site (e.g., palmaris longus, plantaris) and describe the harvest technique in the operative note.
Record laterality (left vs. right hand) in both the operative report and the procedure order.
Describe the tendon condition found intraoperatively — scarring, gap length, pulley status — to support medical necessity and any modifier 22 claim.
If a staged reconstruction with prior silicone rod placement is involved, reference the first-stage operative report by date.

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 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 58 Staged or related 59 Distinct service 62 Co-surgeons 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 26352 covers secondary (delayed, not acute) flexor tendon repair or advancement in the hand or finger when the procedure occurs outside zone 2 and requires a free tendon graft. The surgeon harvests the graft — typically from the palmaris longus or plantaris — and that harvest is bundled into this single code. The zone 2 exclusion is critical: injuries in the flexor tendon sheath between the A1 pulley and FDP insertion are reported with a different code family. If the repair is in zone 2, or if it is primary (at the time of injury), 26352 does not apply.

The 90-day global period means all routine follow-up — wound checks, splint adjustments, and suture removal — is bundled through day 90. Therapy referrals and unrelated E/M visits still need modifier 24. A staged reconstruction that requires a subsequent tendon graft after a silicone rod spacer (Hunter rod) is commonly associated with this code; document the staging explicitly in the operative note.

Bilateral hand procedures are uncommon but do occur in conditions such as rheumatoid arthritis. Apply modifier 50, or LT/RT when payers require laterality codes separately. When 26352 is the secondary procedure in a multi-tendon session, list the highest-RVU code first and append modifier 51 to 26352 unless the payer auto-applies the multiple-procedure reduction.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	7.67
Practice expense RVU	14.94
Malpractice RVU	1.48
Total RVU	24.09
Medicare national rate	$804.63
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	$804.63
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI A2) Ambulatory surgical center (freestanding)	$3,695.53

Common denial reasons

The recurring reasons claims for CPT 26352 get rejected.

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

Missing zone documentation — payers deny or downcode when the operative note does not explicitly state the repair is outside zone 2.
Graft harvest coded separately — the graft harvest is bundled into 26352; billing a separate harvest code triggers a bundling edit and denial.
Lack of secondary-procedure documentation — no reference to prior injury date or failed primary repair causes medical-necessity denials.
Laterality absent — payers requiring LT/RT modifiers will reject claims without them, especially for bilateral repairs billed with modifier 50.
Global-period conflict — post-op E/M visits billed without modifier 24 are denied as included in the 90-day global package.

Frequently asked questions

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

01What makes this a 26352 rather than a primary repair code?

26352 is specifically for secondary repairs — those not performed at the time of original injury. If the surgeon is repairing the tendon acutely (same encounter as the injury), a different code in the 26350–26358 series applies. The operative note must document the gap between injury date and repair date.

02Is graft harvest billed separately?

No. Obtaining the graft is bundled into 26352. Billing a separate harvest code alongside 26352 will trigger an NCCI bundling edit. The operative note should still describe the harvest site and technique.

03How is a staged Hunter rod reconstruction coded?

Stage 1 (silicone rod insertion) and stage 2 (tendon graft via 26352) are separate operative events. Stage 2 billed within the global period of stage 1 requires modifier 58 (staged or related procedure by the same physician). Document the prior rod placement by date in the stage-2 operative report.

04Can 26352 be billed for a zone 2 flexor tendon graft?

No. Zone 2 repairs have their own code. Using 26352 for a zone 2 repair is a coding error that will either be denied on audit or result in recoupment. Confirm zone in the operative note before assigning the code.

05What modifier applies when multiple tendons in the same hand are repaired at the same session?

List the procedure with the highest RVUs first. Apply modifier 51 to 26352 if it is the secondary procedure. Some payers auto-apply the multiple-procedure reduction without modifier 51, but include it unless payer-specific guidance says otherwise. Check payer policy before omitting.

06Does the 90-day global period cover hand therapy referrals?

No. Therapy services billed under a therapist's own NPI are not part of the surgeon's global package. However, if the surgeon bills a separate E/M visit during the 90-day period for a reason unrelated to the tendon repair, modifier 24 is required.

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 operative dictation fields that most frequently trigger denials on 26352: tendon zone (explicitly outside zone 2), laterality, secondary-procedure justification, graft donor site, and pulley status. Auto-populating these from dictation eliminates the leading audit flag — an operative note that says 'flexor tendon repair with graft' without zone or staging detail — before the claim leaves the practice.

See how Mira captures CPT 26352 documentation