Surgical lengthening of a single extensor tendon in the hand or finger, reported once per tendon treated.
Verified May 8, 2026 · 5 sources ↓
- Medicare
- $648.31
- Work RVU
- 5.22
- Global, days
- 90
- Region
- Hand
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 tendon(s) lengthened by name and digit (e.g., extensor digitorum to long finger)
- Document the indication — contracture, deformity, or restricted motion — with pre-op range-of-motion measurements
- Describe the surgical technique used for lengthening (e.g., Z-plasty, step-cut) in the operative note
- Record laterality (right vs. left hand) and finger position for each tendon addressed
- If multiple tendons are treated, list each tendon separately to support multiple units of 26476
- Note any concurrent procedures performed and document separate sites or separate work to support additional codes
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 5 cited references ↓
CPT 26476 covers open surgical lengthening of an extensor tendon in the hand or finger — one unit per tendon. The procedure addresses contracture or deformity caused by a tendon that is too short, restoring range of motion at the affected digit. It is distinct from flexor tendon lengthening (26478), extensor tendon shortening (26477), and tenolysis (26445/26449), so operative notes must clearly document the specific tendon, the direction of the lengthening, and the technique used.
The 90-day global period means all routine follow-up, dressing changes, and related management through day 90 are bundled. If you're billing a separate E/M for an unrelated problem within that window, modifier 24 is required. A staged or planned second procedure on a different tendon during the global period needs modifier 58; an unplanned return to the OR for a related complication takes modifier 78.
When multiple extensor tendons are lengthened in the same session, report 26476 for each tendon with modifier 51 on subsequent units. Use LT/RT to lateralize and modifier 59 or XS if a distinct extensor and flexor tendon lengthening are performed at the same encounter to override potential NCCI bundling with 26478.
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 (5.22) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (19.41) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 5.22 |
| Practice expense RVU | 13.07 |
| Malpractice RVU | 1.12 |
| Total RVU | 19.41 |
| Medicare national rate | $648.31 |
| 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 | $648.31 |
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 26476 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Operative note says 'extensor tendon lengthening' without specifying which tendon or digit, triggering medical necessity denials
- Multiple units billed without modifier 51 or without per-tendon documentation supporting each unit
- Claim submitted without laterality modifier (LT/RT), causing rejection by payers that require it for hand procedures
- Concurrent 26478 (flexor lengthening) denied as unbundled without modifier 59 or XS to establish distinct procedural service
- Post-op E/M billed without modifier 24 during the 90-day global period, resulting in automatic denial
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 5 cited references ↓
01Can I bill 26476 multiple times in the same session if two extensor tendons are lengthened?
02What is the difference between 26476 and 26478?
03How does the 90-day global period affect billing after extensor tendon lengthening?
04Is modifier 50 appropriate for bilateral extensor tendon lengthening?
05When would modifier 22 apply to 26476?
06How does 26476 differ from tenolysis codes like 26445?
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 tendon name, digit, and lengthening technique from the surgeon's dictation and flags laterality for claim attachment. This prevents the most common audit trigger for 26476 — an operative note that documents a hand tendon procedure without identifying which extensor tendon was lengthened and on which finger, which stalls medical necessity review and invites downcoding.
See how Mira captures CPT 26476 documentation