Open repair of the extensor tendon at its distal finger insertion, using a graft — primary or secondary — for conditions such as mallet finger deformity that have failed conservative management or require surgical reconstruction.

Verified May 8, 2026 · 6 sources ↓

Medicare: $693.40
Total RVUs: 20.76
Global, days: 90
Region: Hand

Drawn from CMSAAPCFindacodePayerpriceEatonhand

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify whether repair is primary (acute) or secondary (delayed/revision) in the operative note
Document the exact finger and laterality (LT or RT) affected
Identify graft type, graft source, and harvest site if autograft is used
Describe the open approach and the distal insertion anatomy encountered intraoperatively
Record preoperative deformity (e.g., mallet finger with degree of DIP drop) and failed conservative treatment if secondary repair
Include diagnosis with matching ICD-10 code confirming extensor tendon pathology at the distal insertion

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 58 Staged or related 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 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 6 cited references ↓

CPT 26434 covers an open surgical repair of the extensor tendon at its distal insertion point on the finger, performed with a graft. It applies to both primary repairs (acute) and secondary repairs (delayed or revision). The classic indication is a mallet finger deformity — a dropped distal phalanx caused by disruption of the terminal extensor tendon — where the surgeon restores continuity using suture technique plus graft tissue at the distal insertion.

The 90-day global period means all routine follow-up, wound checks, and splint management through day 90 are bundled. Any E/M visit for a new or unrelated problem in that window requires modifier 24. A staged or planned secondary procedure within the global needs modifier 58; an unplanned return to the OR for a related complication takes modifier 78.

Site-of-service selection matters. The HOPD and ASC payment rates differ substantially — see the site-of-service comparison table. Payers routinely scrutinize whether the graft harvest or graft source is documented, since absence of that detail is a common audit flag for down-coding or denial.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	6.1
Practice expense RVU	13.35
Malpractice RVU	1.31
Total RVU	20.76
Medicare national rate	$693.40
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	$693.40
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 26434 get rejected.

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

Missing documentation of graft use — payers down-code to 26433 (repair without graft) when graft is not explicitly described
Laterality not specified — claims without LT or RT modifier are rejected by many commercial payers
Bundling conflict when tendon sheath injection or local anesthetic injection is billed separately on the same date — those are integral per NCCI policy
ICD-10 mismatch — diagnosis code reflecting a closed mallet finger without confirming surgical indication triggers medical necessity review
Global period violation — post-op E/M visits billed without modifier 24 when the visit is for an unrelated condition

Frequently asked questions

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

01What is the difference between CPT 26433 and 26434?

26433 is repair of the distal extensor tendon insertion without a graft. 26434 requires a graft — document the graft explicitly or the claim will be down-coded to 26433.

02Do I need a laterality modifier for 26434?

Yes. Append LT or RT on every claim. Many commercial payers and MACs reject 26434 without a laterality modifier, and CMS edits flag it on facility claims as well.

03Can I bill for graft harvest separately when performing 26434?

Only if the graft harvest site is a separate, distinct procedure not described within the repair code itself. Document the harvest separately and use modifier 59 or XS to support unbundling, but confirm with your MAC — some bundle routine local graft harvest.

04What modifier applies if the patient returns to the OR during the 90-day global for a tendon re-rupture?

Use modifier 78 — unplanned return to the OR for a procedure related to the original surgery within the global period. Do not use modifier 79, which is reserved for unrelated procedures.

05Can 26434 be billed with an E/M on the same day as surgery?

Only if a significant, separately documented evaluation was performed that led to the surgical decision and is clearly distinct from the pre-op assessment. Use modifier 57 on the E/M when the decision for surgery was made that day.

06How does the 90-day global affect post-op splinting and therapy referrals?

Routine post-op visits and splint management by the operating surgeon are bundled through day 90. Physical or occupational therapy billed by a separate provider is not affected by the surgeon's global period.

Sources & references

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

Mira AI Scribe

The Mira AI Scribe captures the approach (open), tendon location (distal extensor insertion), finger and hand laterality, graft type and harvest site, and whether the repair is primary or secondary — directly from surgeon dictation. This prevents the most common denial for 26434: a claim submitted without explicit graft documentation that gets down-coded to 26433 by the payer.

See how Mira captures CPT 26434 documentation