Open repair of the extensor tendon at its distal insertion on the finger, performed without a graft, either as a primary repair or secondary revision.

Verified May 8, 2026 · 7 sources ↓

Medicare: $567.82
Total RVUs: 17
Global, days: 90
Region: Hand

Drawn from CMSFastrvuAAPCFindacodeEatonhand

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 and which hand (e.g., right long finger, distal phalanx) — laterality omissions are a top edit trigger.
State whether the repair is primary (acute) or secondary (delayed/revision) and the mechanism or chronicity of injury.
Confirm no graft was used; if a graft was required, this code is incorrect — see the grafted-repair code family.
Document the open surgical approach explicitly, not just 'repaired tendon.' Describe incision, tendon identification, and suture technique.
Record pre-op deformity (mallet finger, extensor lag, DIP joint posture) to support medical necessity with a matching ICD-10 diagnosis.
Note prior conservative treatment attempted (splinting duration, compliance) if this is a secondary or delayed repair.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 24 Unrelated E/M during global 25 Significant separate E/M 50 Bilateral procedure 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 XS Separate structure

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 26433 covers an open repair of the extensor tendon at its distal insertion — the point where the tendon attaches at the fingertip — without the use of a graft. This is the workhorse code for operative treatment of mallet finger deformity when conservative splinting has failed or when the injury pattern requires surgical correction. The procedure is coded the same whether it is a primary repair (acute) or secondary repair (delayed or revision).

The 90-day global period governs all post-op care through day 90. Routine splint checks, suture removal, and wound care in that window are not separately billable. If a new, unrelated problem is addressed during the global period, append modifier 24 (E/M) or 79 (unrelated procedure). A same-day E/M requires modifier 25 to survive the NCCI edit.

Site of service matters here: HOPD and ASC payment rates differ substantially from the non-facility rate — see the Site of Service comparison table on this page. When multiple fingers are repaired in the same session, each additional finger requires modifier 59 to distinguish anatomically separate services; bilateral repairs on corresponding fingers of both hands use modifier 50 or LT/RT as appropriate.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	4.58
Practice expense RVU	11.53
Malpractice RVU	0.89
Total RVU	17
Medicare national rate	$567.82
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	$567.82
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 26433 get rejected.

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

Laterality missing from the claim or operative note — payer edits fire when the finger or hand is not specified.
Diagnosis code mismatch: billing an acute traumatic ICD-10 for a chronic mallet deformity, or vice versa, triggers medical necessity denials.
Unbundling error when concurrent procedures on the same finger lack modifier 59 to distinguish separate anatomic services.
Global period conflict — post-op E/M visits billed without modifier 24 during the 90-day global are auto-denied.
Wrong code selected when a tendon graft was actually used; 26433 is graft-free only.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01Does 26433 cover both primary and secondary (delayed) repairs?

Yes. The code applies whether the repair is performed acutely at the time of injury or as a delayed/revision procedure. Document the timing and reason for delay to support medical necessity.

02What if a tendon graft was required?

26433 is explicitly a graft-free repair. If a graft was used to reconstruct the distal extensor insertion, you need a different code from the extensor reconstruction family. Billing 26433 when a graft was placed is a misrepresentation of the service.

03Can I bill 26433 for multiple fingers in the same operative session?

Yes, but each additional finger must be reported separately with modifier 59 (or XS) to identify the services as distinct anatomic sites. Without it, NCCI edits will bundle the additional units.

04How does the 90-day global period affect post-op management?

All routine follow-up — splint checks, wound care, suture removal — is bundled through day 90. Bill an unrelated problem with modifier 79 (procedure) or 24 (E/M). A complication requiring return to the OR for the same issue uses modifier 78.

05Is modifier 25 needed when 26433 is billed with a same-day E/M?

Yes. If the decision for surgery was made at the same encounter and a separately identifiable E/M was performed, modifier 25 on the E/M is required to survive the NCCI edit. Without it, the E/M is denied as bundled into the surgical service.

06What ICD-10 codes are typically linked to 26433?

Common diagnoses include mallet finger (traumatic or chronic), extensor tendon rupture at the DIP level, and late effects of extensor tendon injury. Match the acuity of the diagnosis to the clinical presentation — acute traumatic codes for fresh injuries, sequela or chronic codes for delayed presentations.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

01CMS Physician Fee Schedule 2026
02
cms.gov
https://www.cms.gov
03
fastrvu.com
https://fastrvu.com/cpt/26433
04
aapc.com
https://www.aapc.com/codes/cpt-codes/26433
05
findacode.com
https://www.findacode.com/cpt/26433-cpt-code.html
06
eatonhand.com
https://www.eatonhand.com/coding/n26433.htm
07
cms.gov
https://www.cms.gov/files/document/chapter8cptcodes60000-69999final11.pdf

Mira AI Scribe

Mira's AI scribe captures the finger and hand laterality, repair type (primary vs. secondary), absence of graft, suture technique, and pre-op extensor lag from the surgeon's dictation. That specificity prevents the two most common denials for 26433: laterality omissions and diagnosis-to-procedure mismatches that trigger medical necessity reviews.

See how Mira captures CPT 26433 documentation