Secondary repair of a flexor tendon in the finger or hand, performed more than seven days after the original injury.
Verified May 8, 2026 · 5 sources ↓
- Medicare
- $853.39
- Total RVUs
- 25.55
- Global, days
- 90
- Region
- Hand
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 5 cited references ↓
- Date of original injury must be documented to establish that repair occurred more than seven days post-injury, supporting 26357 over earlier-repair codes.
- Operative note must identify the specific tendon(s) repaired by name, zone, and digit — vague references to 'flexor tendon' without anatomic specificity invite audit flags.
- Document the surgical approach and technique used for the repair, including management of scar tissue or adhesions if encountered.
- Preoperative diagnosis with ICD-10 code(s) that reflect the delayed/chronic nature of the injury should be present on the claim and in the chart.
- If an E&M is billed on the same date with modifier 25, the chart must contain documentation that separately supports a significant, identifiable evaluation beyond the decision to operate.
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 5 cited references ↓
CPT 26357 covers delayed primary or secondary repair of a finger or hand flexor tendon — meaning the repair happens more than seven days after the injury occurred. The timing distinction is clinically and administratively significant: repairs performed within the first seven days fall under a different code. Surgeons performing this procedure are addressing tendon disruption after the acute window has passed, which typically involves more complex dissection, scar tissue management, and tissue handling.
The 90-day global period applies. Every routine post-op visit, wound check, and splint adjustment through day 90 is bundled into the procedure payment. Any E&M service during the global period that addresses a problem unrelated to the tendon repair requires modifier 24. If a separate, significant, and identifiable E&M is documented on the same day as the procedure itself, append modifier 25 — the same-visit evaluation and the procedure do not need different diagnoses, but the E&M must stand on its own documentation.
Local anesthesia administered to perform this repair is not separately reportable. If a distinct therapeutic injection is performed at a separate anatomic site unrelated to anesthesia for this procedure, it may be reportable with an appropriate NCCI-associated modifier, but that scenario should be well-documented.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 10.73 |
| Practice expense RVU | 12.54 |
| Malpractice RVU | 2.28 |
| Total RVU | 25.55 |
| Medicare national rate | $853.39 |
| 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 | $853.39 |
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 26357 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Incorrect timing documentation — payer determines repair occurred within seven days, mapping to a different code and denying 26357.
- Missing or vague operative note lacking tendon identification, zone, or digit, triggering medical necessity or specificity denials.
- Global period violations — post-op E&M visits billed without modifier 24 during the 90-day window are denied as bundled.
- Same-day E&M denied when modifier 25 is absent or when the documentation does not support a separately identifiable evaluation beyond the surgical decision.
- ICD-10 mismatch — injury codes that imply acute onset (less than 7 days) are inconsistent with the secondary-repair code and trigger edits.
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 5 cited references ↓
01What makes 26357 a 'secondary' repair — how is the seven-day cutoff defined?
02Can I bill an E&M on the same day as 26357?
03Does the 90-day global period affect how I bill post-op therapy referrals or hand therapy visits?
04If I repair multiple tendons in the same digit during the same session, how do I code that?
05Is 26357 appropriate for tendon reconstruction or grafting, or just direct repair?
06Can the local anesthesia injection be billed separately when performing 26357?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02cms.govhttps://www.cms.gov/files/document/04-chapter4-ncci-medicare-policy-manual-2026-final.pdf
- 03aapc.comhttps://www.aapc.com/codes/cpt-codes/26357
- 04cms.govhttps://www.cms.gov/medicare/coding-billing/national-correct-coding-initiative-ncci-edits/medicare-ncci-policy-manual
- 05cgsmedicare.comhttps://www.cgsmedicare.com/medicare_dynamic/j15/partb/ptpb/ptp.aspx
Mira AI Scribe
Mira's AI scribe captures the date of original injury, the specific tendon repaired (name, zone, digit), the surgical approach, and the presence of scar tissue or adhesions — the documentation elements that establish both the delayed-repair timing and anatomic specificity. This prevents the two most common denial triggers for 26357: payer challenges to repair timing and operative notes too vague to survive audit.
See how Mira captures CPT 26357 documentation