Surgical repair of an extensor tendon on the dorsum of the hand, primary or secondary, without a free graft — billed per tendon repaired.

Verified May 8, 2026 · 6 sources ↓

Medicare: $598.54
Total RVUs: 17.92
Global, days: 90
Region: Hand

Drawn from AAPCAbosCMSKzanowEbhmc

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify anatomic location as dorsal hand (not finger) and identify the specific extensor tendon(s) repaired by name
State whether repair is primary (within 7 days of injury) or secondary (greater than 7 days post-injury)
Confirm no free graft was harvested — if graft was used, 26412 applies instead of 26410
Document the mechanism and date of injury to support primary vs. secondary classification
If multiple tendons repaired, name each tendon separately to justify billing additional units or lines
Document the surgical approach, suture technique, and intraoperative tendon tension/excursion assessment

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 59 Distinct service 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

26410 covers open repair of an extensor tendon located on the dorsal hand (not the fingers — that's 26418). It applies to both primary repairs (within 7 days of injury) and secondary repairs (more than 7 days post-injury), as long as no free graft is harvested. If a free graft is required, step up to 26412 instead. The descriptor ends in 'each tendon,' which means if the surgeon repairs two separate extensor tendons on the dorsum of the same hand, you report 26410 twice — not once. Some payers accept units; others require modifier 59 or XS on the second line. Confirm payer preference before submitting.

The 90-day global period covers the operative session and all routine postoperative care through day 90. Separate E/M visits for unrelated conditions in that window require modifier 24. A new, unrelated surgical problem needs modifier 79. If the patient returns to the OR for a complication directly tied to the original repair, that's modifier 78 — not 79.

Location matters for code selection. Extensor tendon repairs on the finger are coded 26418 (without graft) or 26420 (with graft). Repairs requiring excision and delayed staged grafting use 26415/26416. Boutonniere deformity central slip repair goes to 26426. Mallet finger repair at the distal insertion uses 26433. Using 26410 for any of those scenarios is a misassignment audit teams catch.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	4.65
Practice expense RVU	12.37
Malpractice RVU	0.9
Total RVU	17.92
Medicare national rate	$598.54
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	$598.54
HOPD (APC 5112) Hospital outpatient department	$1,642.82
ASC (PI A2) Ambulatory surgical center (freestanding)	$872.87

Common denial reasons

The recurring reasons claims for CPT 26410 get rejected.

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

Wrong anatomic level — 26410 is dorsal hand only; finger extensor repairs require 26418 or 26420
Unbundling error when a free graft was harvested but 26410 was billed instead of 26412
Second tendon line denied for lacking documentation that a distinct tendon was separately repaired
Global period conflict — postoperative E/M visit billed without modifier 24 when unrelated to the repair
Laterality missing — LT or RT not appended, triggering payer edit requiring resubmission

Frequently asked questions

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

01What's the difference between 26410 and 26418?

26410 is for extensor tendon repairs on the dorsal hand. 26418 is for extensor tendon repairs on the finger. If the operative note says 'index finger extensor,' that's 26418, not 26410. Using 26410 for finger-level repairs is a common misassignment.

02Can I bill 26410 twice if two extensor tendons were repaired on the same hand?

Yes. The descriptor says 'each tendon,' so two tendons = two units or two lines. Some payers accept 26410 x2; others require 26410 and 26410-59 or 26410-XS. Each tendon must be individually named in the operative note.

03When does a secondary repair become 26412 instead of 26410?

Timing doesn't determine 26412 — graft use does. If the surgeon harvests a free graft to bridge the defect, bill 26412 regardless of whether it's a primary or secondary repair. 26410 applies only when no free graft is used.

04What modifier do I use if the patient returns to the OR within the 90-day global for a repair complication?

Modifier 78. That covers an unplanned return to the OR for a complication directly related to the original procedure during the global period. Modifier 79 is for an unrelated procedure — don't use it for complications of the index repair.

05Is 26410 billable for a boutonniere deformity repair?

No. Boutonniere deformity involving central slip repair with lateral bands goes to 26426, not 26410. Mallet finger at the distal insertion uses 26433. Using 26410 for either is a misassignment that payers and auditors flag.

06Do I need to append LT or RT to 26410?

Most commercial payers and Medicare require laterality modifiers for hand procedures. Omitting LT or RT is a common clean-claim failure that triggers a request for additional information or outright denial on first pass.

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 tendon name, dorsal hand location, injury date, repair timing (primary vs. secondary), and graft status directly from dictation. That prevents the two most common misassignments: defaulting to 26418 when the repair is on the hand rather than the finger, and billing 26410 when a graft was actually harvested. When the surgeon dictates multiple tendons, the scribe flags each by name so the second unit is defensible on audit.

See how Mira captures CPT 26410 documentation