Excision of an extensor tendon from the hand or finger with implantation of a synthetic rod or tube to maintain the tendon gliding channel until a staged tendon graft can be performed.

Verified May 8, 2026 · 5 sources ↓

Medicare: $833.35
Total RVUs: 24.95
Global, days: 90
Region: Hand

Drawn from CMSAAPCEatonhandEmedny

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Specify extensor tendon by name and anatomic location (digit number, palm vs. finger, specific zone)
Document condition of the excised tendon justifying staged reconstruction rather than primary repair
Describe placement of the synthetic rod or tube, including make/material if recorded
Confirm the operative note states 'extensor' — not flexor — to prevent miscoding to 26390
Note whether procedure is performed on one or multiple digits, identifying each separately
Record planned stage-two timing and graft source in the operative plan section

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 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 5 cited references ↓

CPT 26415 covers the first stage of a two-stage extensor tendon reconstruction. The surgeon excises the damaged or scarred extensor tendon and places a flexible silicone rod into the tendon bed. The rod keeps the tissue plane open and induces formation of a pseudosheath — the biological tunnel through which the definitive tendon graft will later pass during stage two. This is a planned staged procedure, not a standalone repair.

The 90-day global period applies. All routine post-op visits, wound checks, and occupational therapy orders written by the operating surgeon fall inside the global. When the stage-two graft procedure occurs within 90 days, bill it with modifier 58 (staged or related procedure by the same physician). If you're billing 26415 on the same claim as 26170 (palm tendon excision) or 26180 (finger tendon excision), expect a bundle — CPT parenthetical instructions explicitly prohibit reporting those codes together with 26415.

Not to be confused with the flexor tendon equivalent (26390), which covers the same two-stage concept on the flexor side. Payer confusion between the two codes is a common source of avoidable denials. Always confirm the operative note specifies extensor versus flexor and palm versus finger before code selection.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	8.3
Practice expense RVU	14.89
Malpractice RVU	1.76
Total RVU	24.95
Medicare national rate	$833.35
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	$833.35
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 26415 get rejected.

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

26170 or 26180 billed same-day — both are bundled into 26415 with no modifier override
26055 (trigger finger release / tendon sheath incision) billed same digit same session — NCCI bundles it with no column-2 modifier bypass
Stage-two graft procedure billed without modifier 58, causing global period denial
Operative note documents flexor tendon work only, mismatching the extensor-specific descriptor of 26415
Multiple digits billed without digit-specific modifiers (F1–F9), causing MUE or duplicate-claim rejection

Frequently asked questions

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

01What is the global period for 26415 and how does it affect billing the stage-two graft?

26415 carries a 90-day global period. When the stage-two tendon graft (typically 26392) is performed within that window by the same surgeon, bill it with modifier 58 to identify it as a planned staged procedure. Without modifier 58, payers will deny it as included in the global.

02Can 26415 and 26055 be billed together on the same finger?

No. NCCI bundles 26055 (tendon sheath incision) into 26415 on the same digit, and no modifier overrides that edit. If tenosynovectomy is performed on a different finger, it may be separately reportable with appropriate digit modifiers.

03How do I bill 26415 when performed on multiple fingers in the same operative session?

Bill a separate line for each digit, using finger-specific modifiers (F1–F9) to identify each. Add modifier 51 to the lower-valued additional procedure lines. Do not stack units on a single line — that triggers MUE edits.

04What is the difference between 26415 and 26390?

26415 covers the extensor tendon side; 26390 covers the same staged rod implantation procedure on the flexor tendon side. The operative note must clearly document which tendon system was involved. Payers audit these and will deny if the documentation contradicts the code billed.

05Is 26415 appropriate for a one-stage primary extensor tendon repair?

No. 26415 is specifically for staged reconstruction involving rod or tube implantation pending a graft. A primary extensor tendon repair in the hand or finger uses different codes in the 26410–26418 range. Using 26415 for a one-stage repair will not match the operative note and creates audit risk.

06Can 26170 or 26180 be billed alongside 26415 if a separate tendon was also excised?

CPT parenthetical instructions explicitly prohibit reporting 26170 or 26180 with 26415, regardless of documentation. These excision codes are considered inclusive to the staged reconstruction procedure. No modifier overcomes this edit.

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 type (extensor), digit number, zone, rod or tube material, and the surgeon's explicit statement that this is stage one of a planned two-stage reconstruction. That detail prevents the most common denial — a payer treating the stage-two graft as an unrelated procedure instead of a planned staged service requiring modifier 58.

See how Mira captures CPT 26415 documentation