Surgical release of a flexor tendon from adhesions spanning both the palm and finger, restoring gliding function across the full tendon excursion.

Verified May 8, 2026 · 6 sources ↓

Medicare: $960.94
Total RVUs: 28.77
Global, days: 90
Region: Hand

Drawn from CMSAAPCBedrockbillingFastrvuMdclarity

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify that tenolysis extended from palm to finger — notes that say 'palm' or 'finger' alone may cause downcode to 26440 or 26441
Name each tendon released (e.g., FDP, FDS) and the specific digit(s) by ray number
Document the surgical approach and extent of adhesion involvement, including zones crossed
Record preoperative TAM (total active motion) measurements to establish functional deficit justifying tenolysis
If modifier 22 is appended, include a separate paragraph in the operative note detailing the specific factors that increased complexity beyond typical tenolysis
Confirm postoperative tendon integrity and excursion achieved intraoperatively — auditors flag notes that omit functional outcome after release

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 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 6 cited references ↓

26442 covers tenolysis of a flexor tendon that extends from the palm into the finger — a single-tendon release performed when adhesions restrict motion across both zones. The procedure requires wider exposure than a palm-only or finger-only release, which is why it carries a higher work value than 26440 (palm only) or 26441 (finger only). Surgeons performing this procedure must free the tendon along its entire adherent length, often through multiple incisions or a single extended approach.

The 90-day global period is the dominant billing reality for this code. All routine postoperative hand therapy referrals, wound checks, and splint adjustments within that window are bundled. If a secondary procedure becomes necessary — planned or unplanned — modifiers 78 or 79 govern what's separately billable. Trigger release (26055) and flexor tenolysis (26442) are NCCI-bundled on the same digit; modifier 59 does not bypass this edit when both procedures are performed on the same finger.

Site of service matters here. HOPD and ASC payments differ substantially — see the site-of-service comparison on this page. Hand Surgery, Orthopedic Surgery, and Plastic and Reconstructive Surgery account for the bulk of claims volume under this code per CMS Physician Utilization File data.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	9.51
Practice expense RVU	17.42
Malpractice RVU	1.84
Total RVU	28.77
Medicare national rate	$960.94
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	$960.94
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 26442 get rejected.

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

Bundling with 26055 (trigger release) on the same digit — NCCI edit stands even with modifier 59
Downcode to 26440 when documentation does not clearly state the release crossed both palm and finger
Missing laterality modifier (LT or RT) required by Medicare and many commercial payers for hand procedures
Insufficient functional deficit documentation — payers deny when preoperative motion limitation is not quantified
Global period conflict when a related E&M or minor procedure is billed in the 90-day window without modifier 24 or 78

Frequently asked questions

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

01What is the difference between 26440, 26441, and 26442?

26440 covers tenolysis limited to the palm only. 26441 covers the finger only. 26442 is the combined release spanning palm and finger on the same tendon. The operative note must document adhesion involvement across both segments to support 26442 — otherwise payers will downcode to the single-zone code.

02Can 26442 and 26055 be billed together on the same digit?

No. NCCI bundles trigger release (26055) and flexor tenolysis (26442) when performed on the same digit. Modifier 59 does not overcome this edit because the procedures share the same anatomic structure in the same encounter. If performed on different digits, use modifier 59 or XS with supporting documentation.

03How many units of 26442 can be reported per session?

26442 is reported per tendon. If multiple tendons are released across palm and finger in the same session, bill additional units with modifier 51. Each tendon must be individually documented in the operative note by name and digit.

04What modifiers are required for bilateral flexor tenolysis?

Use modifier 50 if both hands are treated in the same session. If billed as two line items, apply LT and RT respectively with modifier 51 on the second line. Confirm the payer's preferred bilateral billing format before submitting — some commercial plans require 50, others require separate lines.

05Does the 90-day global period affect hand therapy orders after 26442?

The global period covers the surgeon's own postoperative services, but therapy billed by a separate therapist under their own NPI is not bundled into the surgical global. What is bundled: the surgeon's own follow-up visits, suture removal, and routine checks through day 90.

06When is modifier 22 appropriate for 26442?

Modifier 22 applies when the tenolysis required substantially greater work than typical — for example, dense post-infection fibrosis, revision after prior failed tenolysis, or extensive multi-zone involvement requiring prolonged dissection. The operative note must include a specific narrative explaining the added complexity; a blanket statement is insufficient and will be rejected on audit.

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(s) released by name, digit identified by ray number, the anatomic extent of adhesion (palm zone, finger zone, or both), approach used, and intraoperative excursion achieved after release. That detail prevents the most common audit flag — operative notes that document a generic 'tenolysis' without confirming the palm-to-finger span required to support 26442 over 26440.

See how Mira captures CPT 26442 documentation