Surgical shortening of a single extensor tendon of the hand or finger to correct elongation causing joint instability or functional deformity.
Verified May 8, 2026 · 5 sources ↓
- Medicare
- $613.91
- Work RVU
- 5.19
- 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) shortened by name and anatomic location (e.g., EDC to ring finger)
- Document the clinical indication — joint instability, extensor lag, or deformity — and failure of conservative measures
- Record the surgical technique: amount of tendon resected, method of reapproximation, and approach used
- Specify the finger level using the appropriate modifier (F1–F9) for each tendon billed separately
- Note whether separate incisions were made when multiple tendons are treated at the same session
- Document intraoperative assessment of tension and joint alignment after shortening
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 26477 describes an open surgical procedure in which a hand or finger extensor tendon is shortened — typically by excising a segment and reapproximating the ends — to restore appropriate tension across a joint. The procedure is indicated when tendon elongation has produced instability, extensor lag, or deformity that hasn't responded to conservative management. Each tendon treated is reported separately, so a surgeon shortening three extensor tendons through separate incisions bills 26477 three times with the appropriate finger-level modifiers.
The 90-day global period means all routine follow-up, splinting adjustments, and wound care through day 90 are bundled. Unrelated problems seen during that window require modifier 24 on the E/M. If a complication requires a return to the OR for a related procedure, use modifier 78. If the return is for an unrelated problem, use modifier 79.
Hand Surgery and Orthopedic Surgery are the top billing specialties for this code. Site of service matters: HOPD and ASC payment rates differ substantially — see the site-of-service comparison table on this page.
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 (5.19) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (18.38) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 5.19 |
| Practice expense RVU | 12.2 |
| Malpractice RVU | 0.99 |
| Total RVU | 18.38 |
| Medicare national rate | $613.91 |
| 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 | $613.91 |
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 26477 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Missing finger-level modifier causes unbundling or claim rejection when multiple tendons are billed
- Operative note says 'tendon tightened' without specifying the tendon name, technique, or amount resected — flags as insufficient documentation
- Billing 26477 with another hand tendon repair code without modifier 51 or 59 to establish separate, distinct procedures
- Lack of documented conservative treatment failure prior to surgical intervention
- Global period conflict when post-op visit is billed without modifier 24 for an unrelated condition
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 5 cited references ↓
01Can I bill 26477 multiple times on the same date if I shortened three tendons?
02What finger-level modifiers apply to 26477?
03What is the global period for 26477 and what does it include?
04Can 26477 be billed with other hand tendon codes on the same day?
05What ICD-10 diagnoses commonly support 26477?
06Does site of service affect reimbursement for 26477?
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, finger level, resection amount, reapproximation technique, and intraoperative tension assessment directly from dictation — the four elements auditors most commonly cite as missing when 26477 claims are pulled for review. Locking these details in at the time of dictation prevents the operative note deficiency denials that delay payment on 90-day global cases.
See how Mira captures CPT 26477 documentation