Primary repair or advancement of the flexor digitorum profundus tendon when the superficialis tendon remains intact, performed per finger.
Verified May 8, 2026 · 8 sources ↓
- Medicare
- $759.87
- Total RVUs
- 22.75
- 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 8 cited references ↓
- Confirm and document that the flexor digitorum superficialis is intact at the time of repair
- Specify the zone of injury and the digit(s) involved by name and laterality
- Document timing from injury to surgery to confirm primary repair status
- Record the surgical approach, tendon ends identified, suture technique, and any tendon advancement performed
- Note intraoperative range-of-motion check confirming repair integrity before closure
- Indicate whether one or multiple tendons were repaired; each tendon billed separately
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 8 cited references ↓
CPT 26370 covers primary open repair or advancement of the profundus (FDP) tendon in a digit where the superficialis (FDS) remains intact and functional. 'Primary' means the repair is performed at or near the time of the original injury — generally within days. Each tendon repaired is reported separately; bill one unit of 26370 per finger tendon addressed. The intact superficialis distinguishes this code from repairs performed in Zone 2 (no man's land), which fall under 26356–26358.
The 90-day global period means the operative fee bundles the day-before visit, the surgery itself, and all routine postoperative management through day 90. Unrelated E/M visits in that window require modifier 24; a separate significant E/M on the day of surgery requires modifier 25. Aetna and some other payers bundle 26370 with 26145 (tendon sheath injection/pulley reconstruction); if your procedure is genuinely distinct, append modifier 59 with documentation of a separate anatomic site or separate service.
Code selection hinges on tendon zone, repair timing (primary vs. secondary), and the status of the FDS. If the superficialis is also damaged, a different repair code applies. If a free tendon graft is required, you're in secondary repair territory (26358 family). Operative notes that fail to document FDS integrity, zone of injury, or timing from injury to repair are the top audit flags for this code.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 7.1 |
| Practice expense RVU | 14.31 |
| Malpractice RVU | 1.34 |
| Total RVU | 22.75 |
| Medicare national rate | $759.87 |
| 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 | $759.87 |
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 26370 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Missing documentation of intact superficialis tendon, causing payers to question code selection
- Bundling of 26370 with 26145 by Aetna and certain other payers without modifier 59 and distinct documentation
- Billing as primary repair when operative note or timing from injury suggests secondary repair, triggering a code-selection denial
- Failure to append LT or RT modifier when required by payer policy, causing unprocessable claim
- Global period conflicts when post-op visit billed without modifier 24 during the 90-day global window
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 8 cited references ↓
01How do I bill 26370 when I repair the profundus tendon on two fingers in the same session?
02What makes a repair 'primary' for 26370 purposes, and where is the cutoff?
03When would I use 26356 or 26357 instead of 26370?
04Aetna is bundling 26370 with 26145 — how do I fight that denial?
05Can I bill an E/M visit on the same day as 26370?
06Does the 90-day global period reset if the patient returns for a staged tenolysis?
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
- 03cms.govhttps://www.cms.gov/files/document/2025nccimedicarepolicymanualcompletepdf.pdf
- 04abos.orghttps://www.abos.org/wp-content/uploads/2019/12/sports-cpt-updated.pdf
- 05aaos.orghttps://www.aaos.org/globalassets/quality-and-practice-resources/coding-and-reimbursement/resident-guide/resident-guide_modifiers.pdf
- 06bedrockbilling.comhttps://bedrockbilling.com/static/cci/26370
- 07aapc.comhttps://www.aapc.com/codes/cpt-codes/26370
- 08aoassn.orghttps://www.aoassn.org/wp-content/uploads/2020/12/CodingTTP.pdf
Mira AI Scribe
Mira's AI scribe captures the FDS integrity finding, zone of injury, digit and laterality, timing from injury, suture technique, and intraoperative ROM assessment directly from operative dictation. That prevents the most common audit flag — an operative note that confirms an FDP repair but never explicitly states the superficialis was intact, which is the single fact that distinguishes 26370 from adjacent codes and is the first thing a payer's clinical reviewer looks for.
See how Mira captures CPT 26370 documentation