Open surgical division of a single flexor tendon in the palm, performed through a direct incision.

Verified May 8, 2026 · 6 sources ↓

Medicare: $458.93
Work RVU: 3.7
Global, days: 90
Region: Hand

Drawn from CMSCgsmedicareAAPCPayerpriceAAOS

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Identify the specific tendon(s) by name and finger ray (e.g., FDS ring finger at palm level) — 'flexor tendon' alone is insufficient.
Document laterality explicitly (left vs. right hand) to support LT/RT modifiers and prevent site-mismatch denials.
Operative note must describe the open incision approach and confirm the tendon was surgically divided, not just explored or released percutaneously.
Preoperative diagnosis with supporting clinical findings (e.g., contracture measurement in degrees, triggering grade) linking to the ICD-10 on the claim.
If billing multiple tendon units, document each tendon as a distinct structure with separate surgical action — not as a single procedure covering adjacent structures.
For modifier 22, document the specific factors increasing complexity (e.g., dense adhesions, prior surgery, aberrant anatomy) with time comparison to typical cases.

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 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 26450 covers open tenotomy of a single flexor tendon in the palm — a deliberate surgical cut through the tendon, not a percutaneous release or a tendon repair. The procedure is distinct from tenolysis (26442) and from tenotomy performed at the finger level. If you're billing for multiple tendons in the same palm during the same session, check whether additional units or separate codes apply; the 'each' descriptor in the full code language signals per-tendon billing potential, but NCCI edits and MUE limits govern how many units clear.

The global period is 90 days. All routine post-op management — wound checks, dressing changes, suture removal, and hand therapy coordination that falls within normal recovery — is bundled. Anything genuinely unrelated during that window needs modifier 24 (E/M) or 79 (unrelated procedure). If the patient returns to the OR for a complication tied to the original tenotomy, bill modifier 78, not 79.

Common clinical indications include Dupuytren's contracture with palmar cord involvement, trigger finger with pathology at the palm level, and spastic flexor deformity. Payers expect ICD-10 codes to map precisely to the operative site and indication. Vague diagnosis coding — or using a finger-level ICD-10 when the pathology was palmar — is a frequent audit flag for this code.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU vs. total RVU

The work RVU (3.7) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (13.74) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	3.7
Practice expense RVU	9.35
Malpractice RVU	0.69
Total RVU	13.74
Medicare national rate	$458.93
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	$458.93
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 26450 get rejected.

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

ICD-10 code references a finger-level pathology when the operative site was palmar — payers reject the site mismatch.
Missing laterality: claims without LT or RT are increasingly rejected by commercial payers and some MACs for unilateral hand procedures.
Unbundling denial when 26450 is billed same-day with a comprehensive hand reconstruction code that already includes tendon division as a component.
Modifier 78 omitted on return-to-OR claims during the 90-day global, resulting in automatic denial as a duplicate or bundled service.
Post-op E/M visits billed without modifier 24 during the 90-day global period are denied as included services.

Frequently asked questions

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

01Can 26450 be billed bilaterally in the same session?

Yes. Use modifier 50 if both palms are treated in the same operative session, or LT and RT on separate line items depending on your payer's preference. Verify with the specific payer — some commercial plans require 50, others require split billing with LT/RT.

02What is the global period for 26450, and what does it include?

The global period is 90 days. It bundles the surgery day, the day-before pre-op visit, and all routine post-op care through day 90. Use modifier 24 for unrelated E/M visits and modifier 79 for unrelated procedures during that window.

03How does 26450 differ from 26442 (tenolysis, flexor, palm and finger)?

26450 is a tenotomy — the tendon is cut to release contracture or deformity. 26442 is tenolysis — adhesions are freed to restore tendon gliding without dividing the tendon. The operative note must clearly reflect which procedure was actually performed; they are not interchangeable.

04If the surgeon releases multiple flexor tendons in the same palm at the same session, how is that billed?

The code descriptor includes 'each,' suggesting per-tendon reporting is intended. However, MUE limits and NCCI edits govern how many units will pay. Check the current MUE value for 26450 and document each tendon as a distinct surgical action. Append modifier 59 or XS on additional units as appropriate.

05What modifier applies if the patient returns to the OR with a wound dehiscence related to the original tenotomy?

Use modifier 78 — unplanned return to the OR for a related procedure during the postoperative period. Do not use modifier 79, which is reserved for unrelated procedures. Inverting these two modifiers is a common audit finding.

06Is 26450 performed in an ASC or HOPD setting, and does it matter for billing?

Both settings are common for this procedure. The facility fee differs significantly between HOPD and ASC — see the Site of Service comparison on this page. Physician professional fee RVUs remain the same regardless of setting, but site-of-service modifiers may apply if the procedure occurs in a facility rather than an office.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the tendon name, finger ray, palm level, and surgical approach from dictation, then flags if laterality is missing before the note is finalized. That prevents the two most common 26450 denials — site mismatch and missing LT/RT — before the claim is ever built.

See how Mira captures CPT 26450 documentation