Tenodesis of the distal interphalangeal (DIP) joint of a finger, performed to stabilize the joint by securing the flexor or extensor tendon, reported per joint.

Verified May 8, 2026 · 5 sources ↓

Medicare: $654.99
Work RVU: 5.35
Global, days: 90
Region: Hand

Drawn from CMSCgsmedicareAAOSEmedny

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Identify the specific finger(s) by name or ray number (e.g., right long finger, ray 3)
Confirm the joint level treated is the DIP (distal interphalangeal), not PIP
Describe the tenodesis technique — which tendon was fixed, the method of fixation, and any hardware used
Record the surgical approach and any intraoperative findings that support the procedure
If multiple joints or fingers treated, document each separately with distinct clinical indication
Laterality (left vs. right hand) must be explicit in the operative note and on the claim

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 59 Distinct service LT Left side RT Right side XS Separate structure 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

26474 covers tenodesis at the distal joint of a finger — a stabilization procedure in which the tendon is fixed to limit unwanted DIP joint motion. It is the distal-joint counterpart to 26471, which addresses the proximal interphalangeal (PIP) joint. Report 26474 once per joint treated; if multiple fingers are addressed, append modifier 59 (or an X-modifier) to distinguish separate anatomic sites, or modifier 50 if the identical digit on the contralateral hand is treated bilaterally in the same session.

The 90-day global period applies. That window covers the day-of and day-before surgery, all routine post-op visits, suture removal, and dressing changes through day 90. Any unrelated E/M service billed during the global period requires modifier 24. A new problem addressed on the same day as the procedure requires modifier 25 on the E/M.

Site of service matters for payment. The HOPD and ASC rates differ substantially — see the Site of Service comparison table on this page. Operative documentation must clearly identify the specific finger, the joint level (distal), and the tendon fixation technique to withstand audit scrutiny.

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 (5.35) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (19.61) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	5.35
Practice expense RVU	13.12
Malpractice RVU	1.14
Total RVU	19.61
Medicare national rate	$654.99
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	$654.99
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 26474 get rejected.

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

Missing laterality on the claim — payers require LT or RT modifier; absence triggers automatic denial on many systems
Tenodesis billed without documentation distinguishing distal (DIP) joint from proximal (PIP) joint, causing downcoding to or confusion with 26471
Multiple fingers billed on the same date without modifier 59 or XS to establish each as a distinct procedural service
Bundling conflicts when 26474 is reported alongside overlapping tendon repair or tenotomy codes for the same digit on the same date
Global period violations — post-op E/M visits billed without modifier 24 during the 90-day window

Frequently asked questions

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

01What is the difference between 26471 and 26474?

26471 is tenodesis of the proximal interphalangeal (PIP) joint; 26474 is tenodesis of the distal interphalangeal (DIP) joint. Joint level must be explicit in the operative note — using the wrong code is a coding error, not a modifier situation.

02Can I bill 26474 more than once on the same date if I treated multiple fingers?

Yes. Report 26474 for each joint treated with modifier 59 or XS appended to the additional units to establish each as a distinct procedural service. List the first unit without a modifier or with LT/RT, then append 59/XS to subsequent units.

03Does the 90-day global period affect how I bill post-op visits?

Yes. All routine post-op visits, dressing changes, and suture removals through day 90 are included in the global and cannot be billed separately. Unrelated services need modifier 24 on the E/M; a new problem on the same day as surgery needs modifier 25.

04When is modifier 22 appropriate for 26474?

Modifier 22 applies when the work is substantially greater than typical — for example, extensive scarring from prior trauma or revision after failed prior tenodesis. You need a cover letter with the claim quantifying the extra time and complexity, and documentation in the operative note must support it.

05Should I use modifier 50 or bill with LT and RT on separate lines for bilateral tenodesis?

Follow payer-specific rules. Medicare and most commercial payers accept modifier 50 on a single line for bilateral procedures. Some Medicaid programs require separate line items with LT and RT. Check the payer's billing manual before submitting.

06Is 26474 subject to NCCI bundling with adjacent tendon repair codes?

Potentially, yes. If you perform a tendon repair and a tenodesis on the same digit at the same session, there may be an NCCI edit. Use the CGS NCCI PTP lookup tool to verify the specific code pair and whether a modifier indicator of 1 allows unbundling with 59 or an X-modifier.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the specific finger and ray, joint level (DIP), tendon involved, fixation technique, and laterality directly from operative dictation. That data auto-populates the claim with the correct LT/RT modifier and per-joint unit count — preventing the two most common denial triggers for 26474: missing laterality and undocumented joint level.

See how Mira captures CPT 26474 documentation