Surgical repositioning of a displaced or misaligned extensor tendon in the hand to restore normal finger extension; reported per tendon realigned.

Verified May 8, 2026 · 8 sources ↓

Medicare: $649.65
Total RVUs: 19.45
Global, days: 90
Region: Hand

Drawn from AAPCEatonhandGenhealthPayerpriceCgsmedicare

Documentation requirements

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

Source · Editorial brief grounded in 8 cited references ↓

Specify which digit(s) and which tendon(s) were realigned, by name and anatomic location (e.g., long finger extensor at MCP joint)
Document the underlying pathology driving the realignment — sagittal band rupture, rheumatoid subluxation, post-traumatic deformity, etc.
Describe the surgical technique used: approach, method of tendon centralization, and any repair or reconstruction of the sagittal band or retinacular structures
If multiple tendons are realigned, document each tendon separately to support per-tendon reporting
If billed alongside arthroplasty codes, the operative note must establish that the realignment involved a digit anatomically distinct from the arthroplasty site
Record pre- and intraoperative findings confirming tendon displacement or malalignment, not just incidental repositioning

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 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 8 cited references ↓

CPT 26437 covers open surgical realignment of an extensor tendon in the hand — most commonly the centralization of a subluxed extensor tendon at the metacarpophalangeal (MCP) joint. The classic clinical scenario is ulnar subluxation of a finger extensor tendon caused by sagittal band rupture or rheumatoid disease. The surgeon repositions the tendon to its anatomic track and may repair or reconstruct the sagittal band to hold it there. Code 26437 is reported per tendon, so bilateral or multi-digit cases stack the code with appropriate modifiers.

When performed as part of MCP arthroplasty (26530–26531), extensor realignment is generally considered integral to the arthroplasty and is not separately reportable — AAPC forum guidance and AAOS Global Service Data consistently reflect this bundling. If the realignment is performed on a digit that is not receiving an arthroplasty in the same session, separate reporting with modifier 59 (or XS) and solid documentation of distinct anatomic sites is required.

The 90-day global period applies. All routine post-op splint adjustments, wound checks, and suture removal through day 90 are bundled. Return to the OR for a related complication — such as re-subluxation requiring repeat fixation — bills under modifier 78. An unrelated hand procedure within the global window uses modifier 79.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	5.84
Practice expense RVU	12.49
Malpractice RVU	1.12
Total RVU	19.45
Medicare national rate	$649.65
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	$649.65
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 26437 get rejected.

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

Bundled into same-session MCP arthroplasty (26530/26531) when performed on the same digit — payers consider realignment inclusive
Lack of per-tendon specificity in the operative note makes it impossible to support multiple units billed
Missing or vague documentation of the sagittal band or retinacular pathology, causing medical necessity denials
Modifier 59 or XS absent when billing alongside other hand tendon codes on the same date, triggering NCCI edit denials
Global period conflict when re-billed after a prior hand surgery without modifier 78 or 79 to establish the return-to-OR context

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 8 cited references ↓

01Can 26437 be billed once for each finger realigned in the same session?

Yes. The code descriptor specifies 'each tendon,' so you report one unit per tendon realigned. Each digit and tendon must be individually documented in the operative note to support multiple units.

02Is 26437 separately billable when performed with MCP arthroplasty (26530 or 26531)?

Not on the same digit. Extensor realignment is considered inclusive to the arthroplasty when performed at the same joint. If the realignment involves a different digit that is not receiving arthroplasty, document distinct anatomy and append modifier 59 or XS.

03What modifier applies when the same tendon requires repeat realignment during the 90-day global?

Use modifier 78 for an unplanned return to the OR to correct a related complication (e.g., re-subluxation of the same tendon). Modifier 79 applies only if you're performing a genuinely unrelated procedure in the same global window.

04What ICD-10 codes pair well with 26437 for medical necessity?

Sagittal band rupture (M66.341–M66.349), rheumatoid arthritis with hand involvement (M05.641–M05.649, M06.041–M06.049), and traumatic extensor tendon injury at the hand level (S66.3xx series) are the most common supporting diagnoses.

05Does 26437 require modifier 50 for bilateral same-finger cases, or is that anatomically impossible?

Modifier 50 applies when the same procedure is performed bilaterally — for 26437 that means realigning the corresponding tendon on both hands (e.g., right and left long finger extensor). LT and RT are an acceptable alternative to modifier 50 depending on payer preference. Realigning two tendons on the same hand is not bilateral; just report additional units.

06How does site of service affect reimbursement for 26437?

HOPD and ASC payments differ substantially — see the Site of Service comparison on this page. Surgeon professional fees under the Medicare Physician Fee Schedule follow the facility vs. non-facility RVU split; because this code is almost always performed in a facility setting, the lower facility RVU applies to the professional component.

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 specific tendon name, digit, and MCP joint level from dictation, flags whether sagittal band repair or reconstruction was performed alongside realignment, and records whether any digit receiving realignment also received arthroplasty in the same session. That last flag prevents the single most common denial for this code: billing 26437 as a separate line item on a digit where 26530 or 26531 already covers the work.

See how Mira captures CPT 26437 documentation