Excision of a flexor tendon with implantation of a synthetic rod to prepare the finger or hand for a delayed tendon graft — Stage 1 of a two-stage Hunter rod reconstruction.

Verified May 8, 2026 · 6 sources ↓

Medicare: $851.39
Total RVUs: 25.49
Global, days: 90
Region: Hand

Drawn from CMSEmednyNIHEbhmc

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify which tendon(s) were excised (e.g., FDP zone II, index finger) — 'flexor tendon' alone is insufficient.
Document the extent of tendon scarring or prior injury that makes single-stage repair or grafting unfeasible.
Record the size and position of the synthetic rod implanted, including the specific digit and zone.
Confirm the staged nature of the reconstruction and that Stage 2 (26392) is planned — supports medical necessity for the rod implantation.
Identify the surgical approach and any concurrent procedures performed (e.g., pulley reconstruction) to defend against bundling challenges.
Note laterality (left or right hand) and affected digit in both the operative note and the claim.

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 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 XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 26390 covers Stage 1 of the Hunter two-stage flexor tendon reconstruction: the scarred or damaged flexor tendon is excised and a silicone rod is implanted to create a new tendon sheath (pseudosheath) in preparation for a later graft. It is not a simple tendon repair — it is a staged reconstruction technique used when the tendon bed is too scarred for primary repair or single-stage grafting. Stage 2, rod removal and graft insertion, is reported separately with 26392.

The 90-day global period attaches to 26390. If the patient returns for the planned Stage 2 procedure (26392) within that window, bill 26392 with modifier 58 — staged or related procedure by the same surgeon during the postoperative period. Do not use modifier 79, which is reserved for unrelated procedures. If an unplanned return for a related complication (e.g., rod migration requiring revision) occurs within the global, modifier 78 applies.

Code 26390 carries a 'separate procedure' designation in some contexts — if billed on the same day as a more comprehensive hand procedure, NCCI edits may bundle it. Use modifier 59 or XS only when the rod implantation is genuinely distinct from other same-session work, with documentation to support it.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	9.19
Practice expense RVU	14.34
Malpractice RVU	1.96
Total RVU	25.49
Medicare national rate	$851.39
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	$851.39
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$4,682.29

Common denial reasons

The recurring reasons claims for CPT 26390 get rejected.

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

Missing laterality modifier (LT or RT) — many payers require it on hand surgery claims.
26392 billed without modifier 58 when performed within the 26390 global period, triggering a global period denial.
Insufficient documentation of why single-stage repair or primary graft was not feasible — payers may deny as not medically necessary.
Bundling denial when 26390 is billed same-session with a more comprehensive procedure without modifier 59 or XS and supporting documentation.
Claim submitted with modifier 79 instead of 58 for the planned Stage 2 return — modifier inversion causes systematic denial.

Frequently asked questions

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

01What is the difference between CPT 26390 and 26392?

26390 is Stage 1: excise the damaged flexor tendon and implant a silicone rod to form a pseudosheath. 26392 is Stage 2: remove the rod and insert the actual tendon graft. They are never billed on the same date; Stage 2 typically occurs 8–12 weeks after Stage 1.

02Which modifier goes on 26392 when it falls within the 26390 global period?

Modifier 58 — staged or related procedure by the same surgeon during the postoperative period. Stage 2 is planned at the time of Stage 1, which is exactly what 58 is designed for. Modifier 79 (unrelated procedure) is incorrect here.

03Is an assistant surgeon billable on 26390?

Yes. The eMedNY hand CPT reference and CMS data indicate assistant surgeon is appropriate for 26390. Bill the assistant's service with modifier 80 or AS depending on provider type.

04Can 26390 be billed bilaterally?

Bilateral flexor tendon rod implantation is rare but codeable. Append modifier 50 to a single line and bill at 150% of the fee schedule allowable. Document the clinical rationale for bilateral involvement clearly.

05Does 26390 carry a global period, and how does that affect the Stage 2 visit?

Yes — 26390 has a 90-day global. Routine post-op visits for the rod implantation are included in that global. The Stage 2 surgery (26392) breaks out with modifier 58. A separate E/M for a new, unrelated problem in the global window needs modifier 24.

06What ICD-10 diagnoses typically support 26390?

Common supporting diagnoses include flexor tendon rupture with scarring (M66.3x), postoperative tendon adhesions (M67.8x), traumatic tendon injury sequela (T63-range sequela codes), and failed prior tendon repair. Document specificity to digit and laterality to match the claim.

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 specific tendon excised, affected digit and zone, synthetic rod size and placement, the degree of tendon bed scarring justifying staged reconstruction, and planned timing for Stage 2. This prevents the two most common 26390 denials: vague operative notes that fail medical necessity review and missing laterality that auto-denies at claims adjudication.

See how Mira captures CPT 26390 documentation