Primary repair or advancement of a flexor tendon located in zone 2 of the digital flexor tendon sheath (no-man's land), performed without a free graft, reported per tendon.

Verified May 8, 2026 · 6 sources ↓

Medicare: $753.52
Total RVUs: 22.56
Global, days: 90
Region: Hand

Drawn from CMSAAPCKzanow

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify that the repair is primary (not secondary/staged) and performed without a free graft
Identify the anatomic zone explicitly as zone 2 / no-man's land in the operative note
Name each tendon repaired (e.g., FPL, FDS, FDP) and confirm laterality and digit
Document the mechanism and nature of injury (e.g., laceration, avulsion) to support ICD-10 linkage
Record the repair technique, suture material, and tensioning/advancement method used
If billing multiple units, document each tendon repair separately within the body of the operative note

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 58 Staged or related 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

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 26356 covers primary surgical repair or advancement of a flexor tendon within zone 2 of the digital flexor tendon sheath — the region historically called 'no-man's land' due to its notoriously difficult healing environment. The code applies to repairs performed without a free graft and is reported per tendon, meaning each distinct tendon repaired in zone 2 during the same session generates its own unit of the code. It is the correct code for flexor pollicis longus (FPL) repairs; do not use 26370 for FPL — that code is for flexor digitorum profundus repair with an intact flexor digitorum superficialis.

The 90-day global period means all routine post-op management, dressing changes, and follow-up visits through day 90 are bundled. Bill modifier 24 for unrelated E/M visits during the global window, modifier 78 for an unplanned return to the OR for a related complication, and modifier 79 for an unrelated procedure during the global period. If the patient is inside another surgeon's global period, modifier 79 still applies to your unrelated procedure.

For multiple tendon repairs in zone 2, the code descriptor says 'each tendon,' so bill multiple units or lines. CMS does not allow modifier 59 on a duplicate CPT code for Medicare; use units (26356 x 2) on the Medicare claim. Some commercial payers require 26356-59 on the second line — verify payer-by-payer. Finger-specific modifiers (FA–F9) identify the digit and are strongly recommended to support medical necessity and reduce edit flags.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	9.32
Practice expense RVU	11.45
Malpractice RVU	1.79
Total RVU	22.56
Medicare national rate	$753.52
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	$753.52
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 26356 get rejected.

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

Wrong code selected — 26370 used for FPL repair instead of 26356
Multiple tendon repairs billed without sufficient documentation distinguishing each tendon
Modifier 59 applied on duplicate Medicare line instead of billing additional units
Missing laterality or digit-level modifier causes edit flags or payer-specific denials
Unrelated E/M visit during the 90-day global billed without modifier 24
ICD-10 diagnosis code does not specify zone 2 or flexor tendon injury, creating medical necessity mismatch

Frequently asked questions

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

01Is 26356 the right code for a flexor pollicis longus (FPL) repair?

Yes. 26356 is the correct code for FPL repair. An earlier AAPC coding alert incorrectly directed coders to 26370 for FPL — that was a published correction. 26370 applies to FDP repair with an intact FDS, not FPL.

02Can I bill 26356 twice if two tendons were repaired through the same incision?

Yes. The descriptor says 'each tendon,' so multiple repairs are separately reportable regardless of incision count. For Medicare, bill additional units (26356 x 2). Many commercial payers require a second line with modifier 59 — confirm per payer contract.

03Should I use finger modifiers FA–F9 with 26356?

Yes, and strongly recommended. Finger-specific modifiers identify the exact digit repaired, support medical necessity review, and reduce edit flags when multiple tendon repairs are billed on the same date.

04What is the global period for 26356, and what does it include?

26356 carries a 90-day global period. That covers the day-before visit, the surgery itself, and all routine post-op care through day 90 — including dressing changes, suture removal, and standard follow-up. Use modifier 24 for unrelated E/M visits and modifier 78 for unplanned return to the OR for a related complication during that window.

05When is modifier 22 appropriate with 26356?

Use modifier 22 when the repair required substantially greater work than typical — for example, severely contaminated wounds, extensive scarring in no-man's land, or complex multi-structure involvement. Document the additional time, effort, and complexity explicitly in the operative note; payers will request records.

06Is 26356 ever billed with modifier 62 (two surgeons)?

Rarely, but it is possible when the complexity of the repair — such as simultaneous neurovascular reconstruction — requires two surgeons operating independently in distinct fields. Both surgeons must document their distinct roles, and payer authorization is often required in advance.

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 tendon name, anatomic zone (zone 2 / no-man's land), repair type (primary, no free graft), digit and laterality, and technique from the surgeon's dictation — and flags when the operative note says 'flexor tendon' without specifying which one. That specificity prevents the wrong code selection (e.g., 26370 for an FPL repair) and supports multiple-unit billing when more than one tendon is repaired.

See how Mira captures CPT 26356 documentation