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
Work RVU: 10.73
Global, days: 90
Region: Hand

Drawn from CMSAAPCCgsmedicare

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

22 Increased complexity 24 Unrelated E/M during global 25 Significant separate E/M 51 Multiple procedures 52 Reduced services 57 Decision for surgery 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 AS PA/NP/CNS assistant LT Left side RT Right side

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 vs. total RVU

The work RVU (10.73) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (25.55) adds practice overhead and malpractice, and is what drives the Medicare payment below.

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?

The repair must occur more than seven days after the original tendon injury. Repairs performed within that window are coded differently. The injury date must be documentable from the chart — patient-reported date alone is insufficient if it contradicts other records.

02Can I bill an E&M on the same day as 26357?

Yes, but only if it is a significant and separately identifiable evaluation unrelated to the decision to perform the repair. Append modifier 25 and document the E&M independently. Different diagnoses are not required, but the note must support the additional work.

03Does the 90-day global period affect how I bill post-op therapy referrals or hand therapy visits?

The global only bundles services billed by the operating surgeon. Hand therapy billed by a separate therapist or physical therapy practice is not bundled. However, any post-op E&M or minor procedure you bill during the global needs the appropriate modifier (24 for unrelated E&M, 78 for a related unplanned return to the OR, 79 for an unrelated procedure).

04If I repair multiple tendons in the same digit during the same session, how do I code that?

Report the primary repair with 26357 and additional repairs may warrant add-on or separate codes depending on the tendon and scenario. Review current NCCI edits for any applicable bundles. Modifier 51 may apply for multiple procedures; document each tendon repair distinctly in the operative note.

05Is 26357 appropriate for tendon reconstruction or grafting, or just direct repair?

26357 covers secondary repair of the tendon. If the procedure requires a tendon graft or free tendon transfer, a different code in the 26350–26416 range is likely more appropriate. Confirm the specific procedure matches the code descriptor — auditors look for graft documentation when reconstruction language appears in the operative note under a repair code.

06Can the local anesthesia injection be billed separately when performing 26357?

No. Local anesthesia administered to perform this surgical procedure is not separately reportable per NCCI policy. The only exception would be a distinct therapeutic injection performed at a separate anatomic site for a purpose unrelated to anesthesia for this repair, which would need an NCCI-associated modifier and strong 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 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