Secondary repair of the extensor tendon central slip at the proximal interphalangeal joint using local tissues and lateral bands, performed to correct boutonniere deformity — one finger per unit.
Verified May 8, 2026 · 7 sources ↓
- Medicare
- $475.96
- Total RVUs
- 14.25
- 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 7 cited references ↓
- Specify which finger(s) by name and laterality (e.g., left long finger) — 'finger' alone is insufficient for audit
- Confirm this is a secondary repair; note the duration since original injury or failed conservative treatment
- Describe the central slip condition found intraoperatively and technique used to mobilize and reposition lateral bands
- Document that no free graft was harvested; if graft was used, 26426 is incorrect — use 26428
- Record the boutonniere deformity diagnosis with supporting clinical findings (PIP flexion contracture, DIP hyperextension)
- Include anesthesia type, tourniquet use, and incision approach in the operative note
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 7 cited references ↓
CPT 26426 covers a secondary (delayed) repair of the extensor tendon's central slip at the PIP joint, using only local tissue — including redistribution of the lateral bands back into anatomic position. It does not include free graft harvest; if a free graft is required, bill 26428 instead. The procedure is the definitive surgical treatment for established boutonniere deformity, where central slip attenuation or rupture causes the classic PIP flexion/DIP hyperextension pattern.
Billing is per finger. If you repaired the central slip on two fingers in the same session, report 26426 twice with modifier 51 on the second unit — and confirm each finger is documented separately in the operative note. The 90-day global period captures all routine post-op care, splinting adjustments, and hand therapy referrals generated from that visit; anything unrelated in that window needs modifier 24 or 79.
Site of service matters here. HOPD and ASC reimbursements differ substantially — see the Site of Service comparison on this page. Most carriers expect this done in an outpatient or ASC setting; hospital outpatient billing without documented clinical necessity for that setting can trigger payer scrutiny.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 6.16 |
| Practice expense RVU | 6.92 |
| Malpractice RVU | 1.17 |
| Total RVU | 14.25 |
| Medicare national rate | $475.96 |
| 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 | $475.96 |
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 26426 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Missing laterality — LT or RT modifier absent, triggering claim suspension or rejection
- Billed as primary repair when documentation indicates secondary; mismatched descriptor triggers clinical review
- 26426 and 26428 billed together for the same finger — these are mutually exclusive based on graft use
- Insufficient documentation of boutonniere deformity diagnosis or failed conservative management prior to surgery
- Multiple fingers billed without modifier 51 on additional units, leading to automatic bundling reduction or denial
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 7 cited references ↓
01What is the difference between 26426 and 26418?
02When should I use 26428 instead of 26426?
03Can I bill 26426 for more than one finger in the same session?
04Is modifier 50 appropriate for 26426?
05What ICD-10 codes typically support 26426?
06Does the 90-day global period affect post-op hand therapy referrals?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02emedny.orghttps://www.emedny.org/providermanuals/physician/pdfs/physician%20procedure%20codes%20sect5.pdf
- 03fastrvu.comhttps://fastrvu.com/cpt/26426
- 04aapc.comhttps://www.aapc.com/codes/cpt-codes/26426
- 05findacode.comhttps://www.findacode.com/cpt/26426-cpt-code.html
- 06eatonhand.comhttps://www.eatonhand.com/coding/n26426.htm
- 07genhealth.aihttps://genhealth.ai/code/cpt4/26426-repair-of-extensor-tendon-central-slip-secondary-eg-boutonniere-deformity-using-local-tissues-including-lateral-bands-each-finger
Mira AI Scribe
Mira's AI scribe captures the finger name and laterality, confirms the repair is secondary, documents the central slip condition and lateral band mobilization technique from dictation, and flags whether a free graft was obtained. This prevents the two most common denial triggers: missing laterality and primary-vs-secondary descriptor mismatch that sends claims to clinical review.
See how Mira captures CPT 26426 documentation