Tenodesis of the proximal interphalangeal (PIP) joint using tendon fixation to restore joint stability, reported per joint.

Verified May 8, 2026 · 5 sources ↓

Medicare: $643.64
Work RVU: 5.75
Global, days: 90
Region: Hand

Drawn from CMSAbosAAPCEatonhand

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Specify which digit(s) and which joint level (PIP, not DIP) were treated
Describe the tenodesis technique — lateral band rerouting, direct tendon-to-bone fixation, or other construct
Document the indication: instability type, deformity (e.g., swan-neck, boutonniere), or prior injury
Record intraoperative confirmation of joint stability following tenodesis completion
Note laterality (left vs. right hand) and finger number for each joint treated
If multiple joints addressed same session, list each joint separately in the operative note

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 80 Assistant surgeon LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 26471 describes a surgical tenodesis at the proximal interphalangeal (PIP) joint of a finger, where the surgeon anchors tendon tissue to stabilize the joint and prevent pathologic motion — commonly used for conditions such as swan-neck deformity, boutonniere instability, or post-traumatic PIP laxity. The code is reported per joint, so bilateral or multi-digit procedures require appropriate digit-level modifiers and, where payer policy allows, modifier 51 for multiple procedures billed on the same date.

The 90-day global period means all routine post-op care through day 90 — including splint checks, suture removal, and wound care — is bundled into the surgical payment. Unrelated E/M services during the global require modifier 24. A staged or related secondary procedure in the global window needs modifier 58 or 78, depending on whether it was planned.

26471 (PIP joint) and 26474 (distal joint) are distinct codes; confusing the two is a common audit flag. Document which joint level was treated and specify the technique — tendon-to-bone fixation, lateral band rerouting, or other tenodesis construct — or expect payer queries.

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 (5.75) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (19.27) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	5.75
Practice expense RVU	12.45
Malpractice RVU	1.07
Total RVU	19.27
Medicare national rate	$643.64
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	$643.64
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 26471 get rejected.

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

Wrong joint level coded — 26474 (DIP) submitted when PIP was the operative site
Missing laterality modifier when payer requires digit-level or LT/RT identification
Bundling conflict when 26471 billed same-day with capsulodesis or other PIP stabilization codes without adequate distinction in the operative note
Insufficient documentation of instability indication — payers deny when the note describes only pain without objective joint laxity or deformity
Global period billing errors — post-op visits billed without modifier 24 or 79 within the 90-day window

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01Can I bill 26471 multiple times if I perform tenodesis on more than one PIP joint in the same session?

Yes — 26471 is reported per joint. Bill one unit per PIP joint treated. Append modifier 51 for the secondary procedure(s) and use digit-level HCPCS modifiers (F1–F9) to distinguish which fingers were operated on. Confirm your payer accepts digit modifiers in lieu of or alongside LT/RT.

02What is the difference between 26471 and 26474?

26471 is tenodesis at the proximal interphalangeal (PIP) joint. 26474 is tenodesis at the distal joint (DIP). Submit the code that matches the operative joint level documented in the note — payers cross-reference the code against the operative report.

03Does the 90-day global period affect how I bill post-op hand therapy referrals or splinting?

Hand therapy billed by a separate therapist is not bundled into the surgeon's global. Only services provided by the operating surgeon or their same-group practice are included in the 90-day global. The surgeon's own post-op visits, dressing changes, and suture removal are bundled.

04If I need to return to the OR within the global period to address recurrent PIP instability, which modifier applies?

Modifier 78 applies for an unplanned return to the OR for a complication related to the original tenodesis. If the return procedure was planned at the time of the initial surgery (staged), use modifier 58. Do not use 79 — that is reserved for unrelated procedures during the global.

05Can I bill an E/M on the same day as 26471 if I saw the patient in the office before taking them to surgery?

Only if the E/M was a significant, separately identifiable service beyond the standard pre-operative assessment for this procedure. Append modifier 57 if the E/M was the decision for surgery visit; use modifier 25 if it was a separate medical issue addressed the same day in an outpatient setting.

06Is 26471 appropriate for boutonniere deformity repair?

It depends on the technique. If the surgeon performs a tenodesis construct to stabilize the PIP joint, 26471 is appropriate. Central slip repair using local tissues is captured by 26426. Review the operative note — the code follows the procedure performed, not the diagnosis.

Sources & references

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

01CMS Physician Fee Schedule 2026
02
abos.org
https://www.abos.org/wp-content/uploads/2019/12/hand-cpt-updated.pdf
03
cms.gov
https://www.cms.gov/files/document/2025nccimedicarepolicymanualcompletepdf.pdf
04
aapc.com
https://www.aapc.com/codes/cpt-codes/26471
05
eatonhand.com
https://www.eatonhand.com/coding/n26471.htm

Mira Scribe

Mira's AI scribe captures the joint level (PIP), operative digit and laterality, tenodesis technique, and the documented indication (instability pattern or deformity type) directly from dictation. That specificity prevents the two most common denials for this code: wrong joint level (26471 vs. 26474) and insufficient medical necessity documentation for PIP stabilization procedures.

See how Mira captures CPT 26471 documentation