Removal of a previously placed synthetic extensor tendon rod and insertion of an extensor tendon graft in the hand or finger, including harvest of the graft; reported per rod.

Verified May 8, 2026 · 6 sources ↓

Medicare: $897.15
Total RVUs: 26.86
Global, days: 90
Region: Hand

Drawn from CMSFastrvuEmednyAbosAAOS

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Confirm this is the second stage of a two-stage reconstruction — operative note must reference the prior rod placement (26415) and the approximate interval since stage one.
Identify the specific digit(s) treated and which rod(s) were removed; use the exact finger name or number, not 'the affected finger'.
Document the graft donor site, graft type (palmaris longus, plantaris, extensor indicis proprius, etc.), and that harvest is included in this procedure.
Describe the sheath encountered at rod removal — condition, patency, and suitability for graft passage — to support medical necessity and complexity.
Record any intraoperative findings that deviate from routine, such as sheath contracture, adhesion formation, or graft tensioning decisions, especially if billing modifier 22.

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 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 26416 covers the second stage of a two-stage extensor tendon reconstruction. In stage one (26415), a synthetic silicone rod is implanted to create a gliding tissue sheath around the tendon bed. Once that sheath matures — typically 8 to 12 weeks later — the surgeon removes the rod and threads the harvested tendon graft through the newly formed sheath. Graft harvest is bundled; do not separately bill a bone or tendon graft code for the donor site work.

This is a 90-day global procedure. Stage-one surgery (26415) will almost certainly fall outside that window since the two stages are separated by months, so modifier 79 applies when both stages are billed to the same payer for the same patient. If the stage-two procedure occurs within the global period of any prior unrelated hand surgery, use modifier 79 on 26416 to prevent a global-period denial.

When multiple rods are addressed in the same operative session — for example, index and long fingers simultaneously — bill 26416 for the first and append modifier 51 for each additional unit, unless the payer uses a modifier-51-exempt schedule. Finger-level modifiers (F1–F9) are often required by commercial payers to distinguish which digit was treated; confirm payer requirements before submission.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	9.32
Practice expense RVU	15.56
Malpractice RVU	1.98
Total RVU	26.86
Medicare national rate	$897.15
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	$897.15
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 26416 get rejected.

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

Global period conflict: payer bundles 26416 into the global of a prior hand surgery; modifier 79 (unrelated) or 58 (staged/planned) is required depending on context.
Graft harvest billed separately: separately coding a tendon or bone graft harvest procedure that is already included in 26416 triggers a CCI bundling edit.
Missing stage-one documentation: payer cannot confirm two-stage protocol without reference to prior 26415 or equivalent rod-placement procedure.
Digit not specified: commercial payers require finger-level modifiers (F-series); claims without them are rejected or pended for clarification.
Incorrect staging modifier: using modifier 78 (unplanned return, related) instead of modifier 58 (staged/planned procedure) when stage two follows stage one as planned.

Frequently asked questions

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

01Is graft harvest separately billable with 26416?

No. Obtaining the graft is explicitly included in 26416. Billing a separate graft harvest code will be bundled and denied under NCCI edits.

02Which modifier applies when stage two falls within the global period of stage one (26415)?

Use modifier 58 — staged or related procedure performed during the global period of a prior surgery by the same physician. This is a planned second stage, not an unplanned return, so modifier 78 does not apply.

03How do you bill 26416 when two fingers are treated in the same session?

Bill 26416 for the first rod/graft and add modifier 51 for each additional unit. Many commercial payers also require digit-specific F-series modifiers to distinguish which fingers were treated. Confirm with each payer before submission.

04Can 26415 and 26416 ever be billed on the same date of service?

No. These are staged procedures separated by months. Billing both on the same date of service is clinically implausible and will deny. They represent distinct operative sessions weeks apart.

05What is the global period for 26416, and what does it include?

26416 carries a 90-day global period covering the day before surgery, the procedure itself, and all routine post-op visits through day 90. Splinting, dressing changes, and standard hand therapy coordination during that window are bundled. Unrelated E/M visits require modifier 24.

06When is modifier 22 appropriate for 26416?

Modifier 22 applies when the work is substantially greater than typical — for example, severe sheath contracture requiring extensive lysis before graft passage, or an unusually complex multi-digit reconstruction. Document the specific findings that increased operative time and complexity; without that documentation, payers will strip the modifier and revert to base reimbursement.

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 stage of reconstruction (confirming rod removal and graft insertion), the specific digit(s) treated, graft donor site and type, interval since stage-one rod placement, and intraoperative sheath condition from the surgeon's dictation. That detail prevents the two most common denials for 26416: global-period conflicts caused by missing staging context, and bundling rejections triggered by separately billed graft harvest that is already included in this code.

See how Mira captures CPT 26416 documentation