Open surgical division of a single finger flexor tendon to release contracture or correct deformity.

Verified May 8, 2026 · 6 sources ↓

Medicare: $458.93
Work RVU: 3.67
Global, days: 90
Region: Hand

Drawn from CMSAAPCFastrvuEatonhandAAOS

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify which finger(s) and which tendon(s) were divided (FDP, FDS, or both) and the anatomic level (e.g., A2 pulley zone, proximal phalanx).
Document the clinical indication requiring open rather than percutaneous tenotomy — e.g., fixed flexion contracture degree, prior failed percutaneous attempt, need for direct visualization.
Record the surgical approach and incision type (e.g., Bruner zigzag, mid-lateral) to distinguish from percutaneous code 26060.
Note any concurrent procedures performed on the same digit or hand that may require separate reporting with modifier 59 or XS.
Confirm the diagnosis code aligns with the documented contracture type (joint contracture M24.54x vs. tendon/muscle contracture M62.44x) — auditors flag mismatches.
Identify laterality (right vs. left hand) explicitly in the operative note to support LT/RT modifier billing.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 57 Decision for surgery 58 Staged or related 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 6 cited references ↓

CPT 26455 describes an open tenotomy of a finger flexor tendon — a procedure in which the surgeon makes a deliberate incision through the tendon to release a fixed flexion contracture or address pathologic tendon tension. This is distinct from a percutaneous tenotomy (26060) and from trigger finger sheath release (26055); the open approach is selected when direct visualization is required or when percutaneous technique is insufficient.

The 90-day global period means all routine post-op management through day 90 is bundled. If the decision for surgery was made the same day or the day before, append modifier 57 to the associated E/M. Additional fingers treated in the same session each warrant a separate reporting of 26455 with modifier 59 or XS to distinguish the distinct anatomic structures. Laterality modifiers (LT/RT) are required by most payers to identify which hand.

Flexor tendon contractures most often accompany Dupuytren's disease, burns, prior trauma, or spastic conditions. ICD-10 diagnosis alignment — M24.54x (contracture of joint, finger) or M62.44x (contracture of muscle, hand) — is commonly scrutinized; ensure the operative note specifies the tendon involved, the level of the finger (A1 pulley zone, FDP vs. FDS), and the clinical indication driving the open approach rather than a percutaneous or needle technique.

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 (3.67) 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	3.67
Practice expense RVU	9.38
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 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 26455 get rejected.

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

Unbundling denial when 26455 is billed same-day with 26055 (trigger finger release) or 26060 (percutaneous tenotomy) on the same finger without modifier 59 or XS supporting a distinct structure or separate indication.
Laterality modifier missing — many MACs auto-deny hand/finger codes without LT or RT.
Diagnosis code mismatch between the operative note contracture description and the submitted ICD-10, particularly using a joint contracture code when the pathology is isolated to the tendon.
Modifier 57 missing on a same-day or day-before E/M when the decision for this 90-day global procedure was made at that visit.
Multiple-finger claims denied for lack of individual finger documentation when 26455 is billed more than once — each digit needs independent medical necessity support.

Frequently asked questions

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

01What is the difference between 26455 and 26060?

26060 is a percutaneous tenotomy — a blind needle or stab technique without open exposure. 26455 requires an open incision with direct visualization of the tendon. Use 26455 when the surgeon opens the skin and directly divides the tendon under direct sight. Billing 26455 for a percutaneous technique is an audit target.

02Can 26455 be billed for multiple fingers in the same session?

Yes. Report 26455 for each finger treated, appending modifier 51 on the second and subsequent procedures and modifier 59 or XS to indicate distinct anatomic structures. Each digit needs its own documentation of indication and tendon involved.

03Is modifier 50 appropriate if the same finger on both hands is released?

Modifier 50 applies when the identical procedure is performed on bilateral symmetric structures in the same session. If the same finger (e.g., ring finger) on both the left and right hand is released, modifier 50 is appropriate. Verify with your MAC — some require two line items with LT and RT instead of a single line with modifier 50.

04How does the 90-day global period affect post-op management billing?

All routine follow-up visits, dressing changes, and suture removal through day 90 are bundled. Bill unrelated E/M visits during the global with modifier 24. If you made the decision for surgery the day of or day before the procedure, append modifier 57 to the associated E/M to prevent bundling denial.

05What ICD-10 codes pair correctly with 26455?

M24.54x (contracture of joint, finger) and M62.44x (contracture of muscle and tendon at hand level) are the most common pairings. Match the code to what is actually described — a joint contracture code on a claim where the op note describes only tendon division will trigger a medical necessity review. Specify right or left side in the ICD-10 code to the full 7-character level.

06Can 26455 and 26055 (trigger finger sheath release) be billed together on the same finger?

NCCI edits bundle these codes when performed on the same finger at the same encounter. If they are genuinely separate procedures on distinct structures or for distinct indications, modifier 59 or XS is required with documentation that supports the distinct service. Billing both without modifier support will result in automatic bundling denial.

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 (FDP vs. FDS), finger number, anatomic zone, degree of pre-op flexion contracture, and the surgical rationale for open over percutaneous technique directly from dictation. This prevents the two most common audit flags: operative notes that omit which tendon was cut and records that don't justify the open approach when a percutaneous code exists at lower reimbursement.

See how Mira captures CPT 26455 documentation