Repair of an extensor tendon in a finger, primary or secondary, using a free graft harvested during the same operative session — billed per tendon repaired.

Verified May 8, 2026 · 6 sources ↓

Medicare: $718.12
Total RVUs: 21.5
Global, days: 90
Region: Hand

Drawn from CMSNIHEmednyKzanowFastrvu

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify the exact finger(s) involved — document by name and use FA–F9 modifiers when billing multiple fingers.
State whether the repair is primary (within days of injury) or secondary (delayed or revision), as payers may request this to establish medical necessity.
Describe the graft source — autograft donor site, harvest technique, and graft dimensions — since graft procurement is bundled and must be documented as performed.
Identify the tendon by anatomic name and confirm it is the extensor tendon on the dorsal aspect of the finger, not a zone-2 flexor tendon.
Document the injury mechanism, prior treatment history, and any previous surgical repair for secondary cases.
Record the operative approach, tendon condition at the time of repair, and any concurrent procedures performed under separate codes.

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 LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 26420 covers surgical repair of a finger extensor tendon on the dorsum of the finger when a free graft is required to bridge or reinforce the defect. The graft harvest is included — do not separately bill graft procurement. Primary repair occurs within days of the injury; secondary repair occurs later, either after the initial injury has been allowed to mature or after a prior surgical repair has failed. The 'each tendon' descriptor means you bill one unit per tendon repaired, not one unit per incision.

This code sits in a family of extensor tendon codes. 26418 is the no-graft finger extensor repair; 26420 is the graft-required version. When the repair involves the central slip with boutonnière deformity, look to 26426 or 26428 instead. When repair is at the distal insertion (mallet finger), 26433 or 26434 apply. Selecting the wrong family member is the most common miscoding error on extensor tendon cases.

The 90-day global period covers all routine post-op management, splinting instruction, and wound checks through day 90. Services for unrelated conditions billed in that window require modifier 24 (E/M) or modifier 79 (unrelated procedure). A return to the OR for graft failure or wound complication within the global requires modifier 78 if related, modifier 79 if unrelated.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	6.77
Practice expense RVU	13.45
Malpractice RVU	1.28
Total RVU	21.5
Medicare national rate	$718.12
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	$718.12
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 26420 get rejected.

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

Wrong code family selected — billing 26420 for a flexor tendon repair or a mallet finger repair that belongs under 26433/26434.
Unbundling the graft harvest as a separate procedure — graft procurement is included in 26420 and cannot be billed additionally.
Missing laterality or finger-specific modifier when multiple tendons on different fingers are billed the same date — payers flag duplicate units without FA–F9 or LT/RT distinction.
Global period conflict — separate E/M or procedure billed within the 90-day global without the required modifier 24 or 79.
Insufficient documentation to support secondary repair — no documentation of the prior injury date, prior surgical history, or tendon status at revision.

Frequently asked questions

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

01Can I bill 26420 twice if the surgeon repaired two extensor tendons in the same finger during one session?

Yes. The descriptor reads 'each tendon,' so each repaired tendon is a billable unit. Some payers accept multiple units; others require modifier 59 on the second line to distinguish the services. CMS does not allow modifier 59 on an exact duplicate code, so confirm your MAC's preference before submitting.

02What modifier do I use to identify which finger was operated on?

Use finger-level HCPCS modifiers FA through F9 (thumb through fifth finger, right and left hands). This is especially important when billing 26420 on multiple fingers the same day to avoid medical-review flags for duplicate services.

03Is the graft harvest billable separately with 26420?

No. Graft harvest is explicitly included in 26420. Billing a separate graft procurement code alongside 26420 will be denied as unbundling.

04How does 26420 differ from 26418?

26418 covers extensor tendon repair of the finger without a free graft. 26420 is used when the defect requires a bridging or reinforcing graft. Use the operative note to confirm whether graft was harvested — that's the deciding factor, not the severity of the laceration.

05A patient returns to the OR within the 90-day global for tendon re-rupture at the repair site. What modifier applies?

Modifier 78 — unplanned return to the OR for a complication related to the original procedure. If the return surgery is for a completely unrelated condition, use modifier 79 instead. Do not invert these modifiers; payers audit the distinction.

06Can 26420 be billed for a boutonnière deformity repair?

No. Boutonnière deformity repair involving the central slip is coded to 26426 (local tissue) or 26428 (with free graft). Using 26420 for a boutonnière case will likely survive edits but is incorrect and could surface in a clinical audit.

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 finger location, graft harvest site and dimensions, repair timing (primary vs. secondary), and the specific finger involved — pulling those details directly from the operative dictation. That documentation prevents the two most common audit flags on 26420: misidentification of the tendon type and missing evidence that graft procurement was actually performed during the session.

See how Mira captures CPT 26420 documentation