Secondary repair or advancement of a single flexor tendon in Zone 2 (no man's land) using a free graft, including harvest of the graft.
Verified May 8, 2026 · 5 sources ↓
- Medicare
- $933.22
- Total RVUs
- 27.94
- 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 ↓
- Specify that this is a secondary (not primary) repair — note prior surgery date or injury history
- Identify the exact digit(s) operated on and confirm Zone 2 location within the flexor tendon sheath
- Document the free graft source (e.g., palmaris longus, plantaris, toe extensor) and that harvest was performed at the same session
- Describe the tendon defect size and condition of the tendon sheath, including pulley status
- Record the repair technique used (direct advancement, interposition graft, staged reconstruction) with suture method
- For multi-digit cases, document each finger separately to support billing additional units
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 ↓
26358 covers a secondary flexor tendon repair performed in Zone 2 of the digital flexor tendon sheath — the anatomically hostile stretch from the proximal edge of the A1 pulley to the insertion of the FDS, historically called 'no man's land' because primary repairs in this zone carry high re-rupture and adhesion risk. The procedure involves advancing or re-repairing the flexor tendon and incorporating a free graft to bridge the defect; graft harvest is bundled into the code, so don't separately bill a harvest code.
This is a secondary procedure, meaning the tendon was previously repaired or injured and now requires revision or staged reconstruction. That distinction matters for coding: primary Zone 2 repairs are captured under different codes (26356 without graft, 26357 with graft for primary), while 26358 specifically applies to secondary/revision work with free graft. If you're billing multiple fingers in the same session, report 26358 for each additional finger — the code descriptor is 'each.'
The 90-day global period means all routine post-operative hand therapy evaluations by the surgeon, dressing changes, and suture removals are included through day 90. Separate evaluation or treatment for an unrelated condition in that window requires modifier 24 or 25. A complication requiring a return to the OR for a related procedure uses modifier 78; an unrelated OR procedure uses modifier 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 | 12.29 |
| Practice expense RVU | 13.04 |
| Malpractice RVU | 2.61 |
| Total RVU | 27.94 |
| Medicare national rate | $933.22 |
| 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 | $933.22 |
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 26358 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Missing documentation that this is a secondary repair — payers downcode to primary repair codes if prior surgery is not documented
- Separate billing of graft harvest code when graft is already bundled into 26358
- Insufficient laterality — operative note must specify which hand (LT/RT) to support modifier usage
- Billing 26358 for a primary repair performed in Zone 2, causing code-level mismatch with diagnosis and operative note
- Failure to link appropriate ICD-10 diagnosis codes reflecting tendon rupture or prior repair status, triggering medical necessity denial
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 5 cited references ↓
01What makes 26358 a 'secondary' repair — does timing from injury matter?
02Is graft harvest separately billable when using 26358?
03How do I bill when two fingers are repaired in the same session?
04Which modifier is correct if the surgeon has to return to the OR for tendon re-rupture during the 90-day global?
05Can 26358 be billed with a staged tendon reconstruction using a silicone rod (Hunter rod)?
06Does the site of service affect reimbursement for 26358?
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 secondary repair status, specific digit and zone location, graft source with harvest documentation, pulley integrity, and tendon defect description directly from dictation. This prevents the most common downcode — payers routing 26358 to a primary repair code when the operative note doesn't explicitly call out prior surgical history and Zone 2 anatomy.
See how Mira captures CPT 26358 documentation