Extensor tendon repair of the hand using a free graft, performed as either a primary repair (within seven days of injury) or a secondary repair (more than seven days post-injury).

Verified May 8, 2026 · 5 sources ↓

Medicare: $695.41
Work RVU: 6.32
Global, days: 90
Region: Hand

Drawn from AAPCFindacodeCMS

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Specify primary vs. secondary repair and the time elapsed since injury
Identify the exact tendon(s) repaired by name, digit, and extensor zone
Document the free graft donor site, harvest method, and graft dimensions
State why a free graft was necessary rather than direct tendon repair
Record intraoperative findings including tendon gap, quality of tendon ends, and condition of the tendon sheath
Include laterality (left or right hand) explicitly in the operative note and on 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 59 Distinct service 78 Unplanned return — related 79 Unrelated during global 24 Unrelated E/M during global 25 Significant separate E/M LT Left side RT Right side 80 Assistant surgeon AS PA/NP/CNS assistant

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 26412 covers surgical repair of one or more extensor tendons in the hand using a free tendon graft. The distinction between primary and secondary repair hinges on the seven-day threshold: repairs performed within that window are primary; anything beyond seven days falls under secondary repair. Both are captured by this single code, but your operative note must clearly document which type was performed and why a free graft was required rather than a direct end-to-end repair.

The 90-day global period means all routine post-op care — wound checks, suture removal, splinting adjustments, and hand therapy oversight by the operating surgeon — is bundled into the base payment through day 90. Unrelated E/M services or procedures during that window need modifier 24 or 79, respectively. A new and distinct problem arising in the global period still requires modifier 24 and a different diagnosis to survive audit.

Because this is an open hand procedure with a graft harvest component, document both the recipient site (specific tendon zone and digit) and the donor site for the free graft. Zone of injury matters for clinical context and supports medical necessity when payers question whether a graft was required over primary repair. Laterality modifiers LT and RT are essential — missing them is a common, avoidable denial.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU vs. total RVU

The work RVU (6.32) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (20.82) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	6.32
Practice expense RVU	13.29
Malpractice RVU	1.21
Total RVU	20.82
Medicare national rate	$695.41
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	$695.41
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 26412 get rejected.

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

Missing laterality modifier LT or RT on the claim line
Operative note fails to distinguish primary vs. secondary repair or documents only 'tendon repair' without graft details
Graft harvest not documented, causing payers to question whether 26412 vs. a direct repair code was appropriate
Separate billing for tendon graft harvest or donor-site closure during the global period without modifier support
ICD-10 diagnosis code does not specify laterality or tendon structure, creating a CPT-ICD mismatch

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01What separates a primary from a secondary repair under 26412?

Seven days from injury is the cutoff. Repair within seven days is primary; beyond seven days is secondary. Both bill under 26412, but document the time elapsed clearly — some payers audit this distinction to confirm the graft was clinically justified.

02Can I bill separately for the tendon graft harvest?

Generally no. The free graft is considered part of the 26412 procedure. Separate harvest coding requires a distinct donor-site procedure not integral to the tendon repair, which is uncommon in this context. Check NCCI edits before adding a harvest code.

03If I repair multiple extensor tendons with grafts on different digits same session, how do I bill?

Report 26412 for the first tendon and 26412-51 for each additional tendon repaired. Each line needs the same laterality modifier. Document each tendon individually in the operative note — a single note covering 'multiple tendons' without naming them invites downcoding.

04What modifier applies if the patient returns within the 90-day global for an unplanned reoperation on the same tendon?

Modifier 78 covers an unplanned return to the OR for a complication related to the original repair. Modifier 79 applies if you return for a completely unrelated procedure. Do not invert these — wrong modifier on a global-period return is a common audit finding.

05Is 26412 payable in an ASC setting?

Yes. The ASC payment rate differs substantially from the HOPD rate — see the Site of Service comparison table on this page. Confirm the ASC's covered procedures list before scheduling, as some payers carve out complex hand procedures from ASC coverage.

06Does the 90-day global include hand therapy visits billed by the operating surgeon?

Yes, if the surgeon personally bills for hand therapy or supervised rehabilitation during the global period, that is bundled. Therapy billed by an independent therapist or a separately enrolled provider is not subject to the surgeon's global — those claims go through on their own.

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 injury-to-surgery interval, tendon zone and digit identification, graft donor site and dimensions, and the clinical rationale for graft over direct repair — all from dictation. That prevents the most common audit flag on 26412: an operative note that says 'extensor tendon repair with graft' but omits why the graft was necessary and where it came from.

See how Mira captures CPT 26412 documentation