Removal of a previously placed synthetic flexor tendon spacer rod and replacement with a harvested autograft tendon in the hand or finger — billed once per rod removed.

Verified May 8, 2026 · 6 sources ↓

Medicare: $972.63
Total RVUs: 29.12
Global, days: 90
Region: Hand

Drawn from CMSAbosEatonhandCgsmedicareEmedny

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Identify which finger(s) or hand location treated and number of rods removed
Document the original stage-one rod placement date and surgeon
Record intraoperative findings describing the formed fibrous sheath
Name the donor graft source (e.g., palmaris longus, plantaris, toe extensor) and harvest site
Describe tendon passage technique and method of fixation at both ends
Confirm stage-two is a separate surgical encounter from stage one (distinct date of service)

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 58 Staged or related 59 Distinct service 76 Repeat, same 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 26392 covers the second stage of a two-stage flexor tendon reconstruction. In stage one (CPT 26390), a synthetic rod is implanted to create a smooth fibrous sheath where the damaged tendon once ran. CPT 26392 is the stage-two procedure: the surgeon reopens the prior incision, removes the rod, harvests a donor tendon graft (commonly from the palmaris longus or plantaris), and threads the graft through the newly formed sheath. The graft harvest is bundled — do not separately report a graft procurement code.

Bill 26392 once per rod removed. When a single operative session addresses multiple rods in different fingers, bill additional units with modifier 59 (or XS) to establish distinct anatomical sites. The 90-day global period begins on the date of the stage-two surgery, not stage one. Any staged or planned additional procedures within that global window require modifier 58; unplanned returns to the OR for a related complication require modifier 78.

Stage one (26390) and stage two (26392) are not performed on the same date; they are separated by weeks to months to allow sheath maturation. Billing both codes on the same date of service will trigger an NCCI edit denial. Payers routinely request operative notes for both stages, so document the original rod placement date, the interval, and intraoperative findings at sheath formation.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	10.24
Practice expense RVU	16.7
Malpractice RVU	2.18
Total RVU	29.12
Medicare national rate	$972.63
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	$972.63
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 26392 get rejected.

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

Graft harvest billed separately — procurement is included in 26392 and bundles under NCCI
26390 and 26392 billed same date of service, triggering NCCI PTP edit
Missing documentation of prior rod implantation, causing medical necessity denial
Multiple rods billed without modifier 59/XS to identify distinct anatomical sites
Global period conflict when stage-two falls within the 90-day global of an earlier hand procedure billed by the same surgeon

Frequently asked questions

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

01Is graft harvesting separately billable with CPT 26392?

No. The code descriptor explicitly includes obtaining the graft. Separately reporting a graft procurement code (e.g., 20924) will be denied under NCCI bundling rules per the CMS NCCI Policy Manual Chapter 4.

02Can I bill 26390 and 26392 on the same date of service?

No. Stage one (26390) and stage two (26392) are performed weeks to months apart. Billing both on the same DOS triggers an NCCI PTP edit and the Column 2 code denies. If circumstances forced both on the same day, document extensively and expect payer-level review — this is not a standard clinical scenario.

03How do I bill when multiple rods are removed in the same session?

Bill 26392 for each rod removed. For rods in separate fingers, append modifier XS (or 59) to additional units to identify distinct anatomical structures. Document each finger by name and rod number in the operative note.

04What modifier applies if stage two falls during the global period of another hand procedure?

Use modifier 79 if stage two is unrelated to the original procedure driving the global period. Use modifier 58 if stage two was planned and staged from the original operative episode. Do not use modifier 78 — that applies only to unplanned returns to the OR for a related complication.

05Does the 90-day global period for 26392 count from the stage-one rod placement?

No. The global period starts on the date of the stage-two surgery (26392), not the stage-one implant date. Routine follow-up visits through day 90 after the stage-two procedure are bundled and not separately billable.

06When is modifier 22 appropriate for CPT 26392?

Append modifier 22 when the work is substantially greater than typical — for example, severe scarring from prior trauma, failed prior grafts requiring extensive sheath revision, or unusually prolonged operative time. Pair it with a cover letter citing operative time, complexity, and comparison to the typical procedure.

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 finger or hand location, rod count removed, fibrous sheath quality observed at surgery, graft source and harvest site, fixation method, and the stage-one date from dictation. That detail prevents the two most common denials for 26392: a missing prior-rod-placement record that triggers medical necessity rejection, and an unbundled graft harvest code flagged by NCCI.

See how Mira captures CPT 26392 documentation