Surgical release of a flexor tendon adhered within the palm or finger, restoring gliding function through the tendon sheath.

Verified May 8, 2026 · 6 sources ↓

Medicare: $642.63
Total RVUs: 19.24
Global, days: 90
Region: Hand

Drawn from CMSAAPCCgsmedicareAAOS

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Operative note must specify the exact digit(s) and anatomic zone (palm vs. finger) where tenolysis was performed.
Document the extent of adhesions encountered — diffuse peritendinus scarring vs. localized — to support medical necessity.
Record active range of motion testing performed intraoperatively under local anesthesia to confirm tendon excursion after release.
Pre-operative documentation must show failure of conservative management (hand therapy, passive ROM exercises) before proceeding surgically.
If multiple digits are released at the same session, operative note must individualize findings and technique for each digit to support separate line billing with digit modifiers.
Distinguish the procedure from trigger finger release (26055): note that the A1 pulley was intact or was not the primary target of the procedure.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 59 Distinct service LT Left side RT Right side 79 Unrelated during global 78 Unplanned return — related 24 Unrelated E/M during global 25 Significant separate E/M

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 26440 describes open tenolysis of a flexor tendon in the palm or finger — a procedure that frees a tendon bound down by adhesions within its sheath, typically following trauma, infection, or prior surgery. The surgeon exposes the tendon, excises or releases the restricting scar tissue, and verifies active gliding under local anesthesia before closure. It is performed when conservative therapy and passive range of motion have plateaued but active motion remains limited.

Distinguish 26440 from 26055 (trigger finger release), which addresses a constricting A1 pulley — not tendon adhesions — and from 26145 (tenosynovectomy of the finger or palm), which involves synovial lining excision rather than adhesion release. Billing 26440 when the operative note documents only a pulley incision for trigger finger is upcoding; the distinction hinges on what the surgeon actually did and why.

26440 carries a 90-day global period. All routine post-op hand therapy evaluations, dressing changes, and suture removals performed by the operating surgeon through day 90 are bundled. A separately identifiable E/M on the same day as surgery requires modifier 25 (pre-op decision-making beyond normal surgical judgment). If a second tenolysis is performed on a different finger at the same session, append the appropriate digit modifier to each line.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	5.03
Practice expense RVU	13.25
Malpractice RVU	0.96
Total RVU	19.24
Medicare national rate	$642.63
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	$642.63
HOPD (APC 5112) Hospital outpatient department	$1,642.82
ASC (PI A2) Ambulatory surgical center (freestanding)	$872.87

Common denial reasons

The recurring reasons claims for CPT 26440 get rejected.

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

Code billed as 26440 when operative note describes only A1 pulley incision for trigger finger — correct code is 26055.
Missing pre-operative conservative treatment documentation, causing medical necessity denial.
Multiple digits released same session billed with modifier 59 instead of digit-specific F-modifiers, triggering NCCI PTP edits.
Tenosynovectomy (26145) billed alongside 26440 for the same digit — tenosynovectomy is bundled into tenolysis under AAOS global service guidelines.
Post-operative hand therapy evaluation billed by the surgeon within the 90-day global period without modifier 24 establishing an unrelated diagnosis.

Frequently asked questions

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

01What is the difference between 26440 and 26055, and why does it matter for billing?

26055 is trigger finger release — an incision of the constricting A1 pulley. 26440 is tenolysis — freeing a tendon bound by adhesions within its sheath. The distinction is what structure was addressed. Billing 26440 when only the A1 pulley was incised is upcoding and a common audit target.

02Can 26440 and 26145 (tenosynovectomy) be billed together for the same digit?

No. Tenosynovectomy is considered a component of tenolysis for the same digit under AAOS global service guidelines. Billing both for the same digit is unbundling. If tenosynovectomy was the sole procedure on a separate digit, use digit modifiers to differentiate.

03How do you bill if tenolysis is performed on multiple fingers in the same operative session?

Bill 26440 on separate lines with digit-specific F-modifiers (FA–F9) for each finger released. Append modifier 51 to the secondary procedures. Use modifier 59 only when F-modifiers are insufficient to resolve an NCCI edit — F-modifiers should take priority.

04What global period applies to 26440, and what does it cover?

26440 has a 90-day global period. That covers the surgery, the day-before pre-op visit, and all routine post-op care by the operating surgeon through day 90 — including dressing changes, suture removal, and related hand therapy evaluations. Unrelated services in that window need modifier 24.

05Is an E/M visit billable on the same day as 26440?

Only if the E/M was a significant, separately identifiable service beyond the decision to perform the tenolysis — for example, evaluating a comorbidity or a new complaint unrelated to the operative digit. Append modifier 25 and document the distinct decision-making in the note.

06Does site of service affect payment for 26440?

Yes. The HOPD and ASC payments differ — see the site of service comparison table on this page. ASC payment is notably lower than HOPD. For practices choosing the surgical setting, that differential can be a meaningful factor in facility contracting decisions.

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 digit and anatomic zone of the tenolysis, the extent and character of adhesions found, intraoperative active ROM testing results, and confirmation that the A1 pulley was not the primary pathology. That last point prevents the most common audit flag on 26440: an operative note that reads identically to a trigger finger release (26055), which reimbursement is significantly lower.

See how Mira captures CPT 26440 documentation