Surgical release (tenolysis) of an extensor tendon in the hand or finger, performed to free the tendon from adhesions that restrict movement; billed per tendon.

Verified May 8, 2026 · 7 sources ↓

Medicare: $604.89
Total RVUs: 18.11
Global, days: 90
Region: Hand

Drawn from CMSAAPCMdclarityEmednyAAOS

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Identify the specific tendon(s) released by name and anatomical location (e.g., extensor digitorum communis to long finger at zone IV)
Document the extent of adhesions encountered and the technique used to achieve full passive and active tendon excursion intraoperatively
Record pre- and post-release range of motion or tendon excursion measured in the OR to support medical necessity
Specify laterality (right vs. left hand) and the digit or metacarpal level involved
If multiple tendons released, document each tendon separately to support per-tendon billing
Confirm the procedure is extensor (not flexor) and confined to hand or finger — not extending into forearm — to distinguish from 26449

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 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 7 cited references ↓

CPT 26445 covers tenolysis of an extensor tendon in the hand or finger — an open surgical procedure that frees the tendon from scar tissue or adhesions limiting glide and function. The code is reported per tendon, so if two extensor tendons are released through the same or separate incisions at the same session, bill 26445 twice with modifier 59 or XS on the second unit to justify separate reporting.

Distinguish 26445 from its neighbors: 26440 and 26442 are flexor tendon tenolysis codes; 26449 is the complex extensor tenolysis extending into the forearm. If you're releasing the extensor at the distal insertion (mallet deformity), that's 26433 territory — and NCCI bundles 26445 into 26433 when performed on the same tendon through the same incision.

26445 carries a 90-day global period. Post-op visits, dressing changes, and suture removal within that window are included. Anything unrelated to the tenolysis billed during the global requires modifier 24 (E/M) or 79 (procedure). A return to the OR for a related complication — say, re-adhesion requiring repeat release — bills with modifier 78.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	4.34
Practice expense RVU	12.94
Malpractice RVU	0.83
Total RVU	18.11
Medicare national rate	$604.89
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	$604.89
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 26445 get rejected.

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

Bundling into 26433 when tenolysis and extensor repair are billed for the same tendon through the same incision on the same date
Missing laterality modifier (LT or RT) required by many payers and all Medicare claims for unilateral hand procedures
Insufficient documentation of medical necessity — operative note lacks pre-op functional deficit, failed conservative care, or intraoperative excursion findings
Unbundling denial when multiple units of 26445 are billed without modifier 59 or XS to establish distinct tendons
Global period conflict — post-op E/M or minor procedure billed without modifier 24 or 79 within the 90-day global window

Frequently asked questions

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

01Is 26445 billed per tendon or per finger?

Per tendon. If two extensor tendons are released in the same session, report 26445 twice. Append modifier 59 or XS to the second unit to indicate a distinct tendon structure and prevent automatic bundling denial.

02What's the difference between 26445 and 26449?

26449 is the complex extensor tenolysis that extends into the forearm — it requires a more extensive dissection and carries higher work value. Use 26445 when the release is confined to the hand or finger only.

03Can 26445 and 26433 be billed together?

Not on the same tendon through the same incision. NCCI bundles 26445 into 26433 in that scenario. If the tenolysis is performed on a separate tendon from the repair, modifier 59 or XS may support distinct reporting — but document it precisely.

04Which modifier do I use for a bilateral extensor tenolysis performed in the same session?

Report 26445 once with modifier 50 for a true bilateral procedure. Some payers prefer two line items with LT and RT instead — check your specific payer's billing instructions before submitting.

05What does the 90-day global period mean for post-op care billing?

All routine post-op management, wound care, and suture removal through day 90 are bundled into the 26445 payment. Bill a related E/M with modifier 24 only if it addresses a new or unrelated problem; use modifier 79 for an unrelated procedure in the global window, and modifier 78 for an unplanned return to the OR for a related complication.

06Does 26445 require a specific diagnosis code to support medical necessity?

Yes. Common supporting diagnoses include tendon adhesions (M67.8x), post-traumatic stiffness, or sequelae of prior tendon repair. Payers may deny without a diagnosis that clearly explains why tenolysis — rather than continued therapy — was necessary. Document failed conservative management in the pre-op note.

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 tendon name, digit, zone, and laterality from dictation, along with intraoperative excursion measurements and the extent of adhesiolysis performed. It flags operative notes that omit tendon-level specificity or fail to distinguish extensor from flexor release — both common triggers for NCCI bundling disputes and per-tendon billing denials.

See how Mira captures CPT 26445 documentation