Open surgical division of an extensor tendon in the hand or finger, performed as a discrete tenotomy on each tendon addressed.

Verified May 8, 2026 · 7 sources ↓

Medicare: $448.57
Work RVU: 3.49
Global, days: 90
Region: Hand

Drawn from CMSEmednyCgsmedicare

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 extensor tendon(s) divided by anatomical name — e.g., extensor digitorum communis to long finger, extensor indicis proprius — not just 'extensor tendon'.
Confirm the approach is open, with direct visualization; percutaneous releases cannot be reported under 26460.
Document the clinical indication driving the tenotomy (e.g., spasticity, boutonnière deformity, fixed contracture) with supporting exam findings.
If multiple tendons are released, document each tendon separately in the operative note to support each billed unit of 26460.
Record the digit and hand laterality (LT/RT) explicitly — payers match this against the diagnosis code.

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 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 26460 describes an open tenotomy of an extensor tendon in the hand or finger — a deliberate surgical cut through the tendon to release tension, correct deformity, or address pathology such as swan-neck or boutonnière deformity, spasticity, or trigger-related extensor tethering. 'Open' distinguishes it from percutaneous approaches; the surgeon must directly visualize and divide the tendon through a formal incision.

The descriptor applies per tendon, so if two extensor tendons are released at the same operative session, report 26460 twice — once with the primary listing and once with modifier 51 to indicate multiple procedures. Each unit must be supported by separate operative documentation identifying the specific tendon divided. Confusing this code with 26445 (extensor tenolysis) or 26455 (flexor tenotomy, finger) is a common source of denials; tenotomy means division, tenolysis means freeing adhesions — the operative note must make clear which was done.

The 90-day global period means all related E&M visits, wound checks, and routine postoperative management through day 90 are bundled into the procedure payment. Bill modifier 24 for unrelated E&M services during the global window, modifier 78 for an unplanned return to the OR for a related complication, and modifier 79 for an unrelated procedure during the global period.

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 (3.49) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (13.43) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	3.49
Practice expense RVU	9.29
Malpractice RVU	0.65
Total RVU	13.43
Medicare national rate	$448.57
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	$448.57
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 26460 get rejected.

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

Operative note says 'tenolysis' or 'release' without specifying surgical division; payers recode or deny when the procedure type is ambiguous.
Missing laterality modifier (LT or RT) on the claim, causing automated rejection before clinical review.
Multiple units of 26460 billed without modifier 51 on the second and subsequent tendons, triggering NCCI bundling edits.
Diagnosis code reflects a flexor tendon condition when an extensor tenotomy was performed — CPT-ICD mismatch flagged on edit.
Related E&M billed during the 90-day global period without modifier 24 or 25, resulting in automatic denial under the global surgery package.

Frequently asked questions

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

01What is the difference between 26460 and 26445?

26460 is a tenotomy — the tendon is surgically divided. 26445 is a tenolysis — adhesions are freed but the tendon remains intact. The operative note must use language that clearly supports division to justify 26460; auditors will recode to 26445 if the note only describes freeing the tendon from scar tissue.

02Can I bill 26460 twice if I release two extensor tendons on the same hand in the same session?

Yes. 26460 is a per-tendon code. Report the first tendon as 26460 and the second as 26460-51. Each unit must be backed by operative documentation identifying the specific tendon divided. Without modifier 51, NCCI edits will deny the second unit.

03Is a same-day E&M billable with 26460?

Only if it is a significant, separately identifiable service unrelated to the decision to perform the tenotomy. Add modifier 25 to the E&M. If the visit is solely the preoperative evaluation leading to the tenotomy, it is bundled.

04What modifiers handle bilateral extensor tenotomies performed in one session?

Use modifier 50 if both hands are operated on. Use LT and RT on separate claim lines if your payer requires bilateral billing that way instead. Confirm your payer's bilateral billing preference before submitting — Medicare and many commercial payers differ on line-item versus modifier-50 format.

05How does the 90-day global period affect post-op hand therapy referrals and follow-up billing?

Routine post-op visits by the operating surgeon are bundled through day 90. Hand therapy billed by a separate therapist is not part of the surgeon's global package. If the surgeon sees the patient for an unrelated condition during the global window, append modifier 24 to the E&M and document the distinct reason.

06Can 26460 be reported with a wound closure code?

No. Per NCCI policy, closure of a surgical incision is included in the global surgical package for procedures with a 090-day global period. Wound repair codes 12001–13153 cannot be billed separately for closure of the tenotomy incision.

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 and anatomical level from dictation, the surgical approach (open vs. percutaneous), the digit and laterality, and the clinical indication. It flags the note if the operative description uses 'release' or 'tenolysis' language without confirming division — the ambiguity that most often triggers a recode to 26445 or an outright denial. If multiple tendons are documented, the scribe queues modifier 51 automatically on the second unit.

See how Mira captures CPT 26460 documentation