Surgical repair of a finger extensor tendon without a free graft — primary (acute) or secondary (delayed) — billed per tendon repaired.
Verified May 8, 2026 · 5 sources ↓
- Medicare
- $627.60
- Total RVUs
- 18.79
- Global, days
- 90
- Region
- Hand
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 5 cited references ↓
- Identify the specific finger(s) treated — digit-level specificity is required for F modifier assignment
- State whether the repair is primary (acute) or secondary (delayed) and document the timing relative to the injury
- Describe the surgical approach and the zone of injury on the extensor surface of the finger
- Confirm no free graft was harvested — if a graft was used, 26418 is the wrong code
- Document each tendon repaired separately when billing multiple units of 26418
- Include the repair technique (suture type, configuration, and number of strands) to support medical necessity and modifier 22 if applicable
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 5 cited references ↓
CPT 26418 covers open repair of a finger extensor tendon on the dorsum of the finger, performed without harvesting a free tendon graft. The code applies whether the repair is primary (performed shortly after an acute laceration or rupture) or secondary (delayed repair after failed initial healing). It is billed per tendon, so multiple tendons repaired in the same session on different fingers can each support a separate unit of 26418 — but MUE limits apply, and you'll need to verify per-line unit counts with your MAC before billing more than two or three units on a single claim.
The 90-day global period means any routine post-op management, splinting adjustments, and dressing changes through day 90 are bundled. If you're seeing the patient for an unrelated problem in that window, append modifier 24 to the E/M. Staged tenolysis or other planned follow-up procedures in the global use modifier 58; an unplanned return to the OR for a related complication (e.g., re-rupture) uses modifier 78.
Finger-level modifiers (F1–F9) are essential. Payers — including Medicare — require them to distinguish which specific digit was treated. Omitting a finger modifier is a straightforward claim edit trigger. When multiple fingers are repaired, list each tendon on its own line with the appropriate F modifier.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 4.36 |
| Practice expense RVU | 13.58 |
| Malpractice RVU | 0.85 |
| Total RVU | 18.79 |
| Medicare national rate | $627.60 |
| 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 | $627.60 |
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 26418 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Missing finger-level modifier (F1–F9) — payers reject or bundle unspecified digit claims
- Billing multiple units of 26418 without distinct per-tendon documentation for each unit
- Using 26418 when a free graft was employed — requires a different code
- Post-op E/M visits billed without modifier 24 inside the 90-day global period
- Duplicate claim edit when two surgeons from the same practice each submit 26418 for the same patient and date without modifier 62 or appropriate distinction
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 5 cited references ↓
01Can I bill 26418 more than once when I repair extensor tendons on two different fingers in the same session?
02What's the difference between primary and secondary repair for billing purposes?
03Which finger modifiers apply to 26418?
04What happens if I bill an E/M visit during the 90-day global period?
05Is modifier 22 supportable for a complex extensor tendon repair?
06Does 26418 apply to thumb extensor tendon repairs?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02aapc.comhttps://www.aapc.com/codes/cpt-codes/26418
- 03eatonhand.comhttps://www.eatonhand.com/coding/cpt27dc.htm
- 04axogeninc.comhttps://www.axogeninc.com/wp-content/uploads/2025/04/2025-Neuroplasty-Tendon-Release-Coding-Guide.pdf
- 05aapc.comhttps://www.aapc.com/codes/coding-newsletters/my-orthopedic-coding-alert/hand-surgery-try-your-hand-at-these-5-surgery-coding-questions-145432-article
Mira AI Scribe
Mira's AI scribe captures the digit name and number (e.g., left ring finger, F7), repair timing (primary vs. secondary), zone of injury on the extensor surface, suture technique, and explicit confirmation that no free graft was used. That detail set populates the F modifier automatically and prevents the two most common edit triggers — missing digit specificity and graft-status ambiguity — before the claim is ever built.
See how Mira captures CPT 26418 documentation