Tendon transfer or transplant performed in the carpometacarpal area or dorsum of the hand, using the patient's own local tendon without a free graft — billed per tendon moved.

Verified May 8, 2026 · 7 sources ↓

Medicare: $668.02
Total RVUs: 20
Global, days: 90
Region: Hand

Drawn from CMSAAPCMdclarityEatonhandEmedny

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 tendon(s) transferred by anatomic name (e.g., EPB, APL, ECRL) — not just 'tendon transfer performed'
Confirm the operative site is the carpometacarpal area or dorsum of the hand, not the palm or fingers
State explicitly that no free tendon graft was harvested or used — required to differentiate from 26483
Document the indication: tendon dysfunction, rupture, nerve palsy, or joint instability driving the functional deficit
Record each tendon transferred separately if multiple tendons are addressed, supporting per-tendon billing
Include intraoperative findings, approach, fixation method (suture, anchor, bone tunnel), and tension setting

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 59 Distinct service 76 Repeat, same physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 26480 covers a single tendon transfer or transplant within the carpometacarpal region or dorsal hand, where the surgeon reroutes an existing tendon to restore lost function — without harvesting a separate free graft from another site. The 'without free graft' distinction is critical: if a free graft is taken and used, report 26483 instead. The code is reported per tendon, so each additional tendon transferred at the same session is billed with a separate unit and modifier 51.

Common clinical scenarios include EPB-to-APL transfers for thumb CMC instability and extensor tendon rerouting after radial nerve palsy or tendon rupture from inflammatory arthritis. The carpometacarpal region includes the articulation between the wrist's carpal bones and the proximal metacarpal bases — not the fingers themselves. Transfers in the palm use 26485 (without graft) or 26489 (with graft).

The 90-day global period applies. All routine post-op visits, dressing changes, and splint checks through day 90 are bundled. Unrelated procedures in that window require modifier 79; unplanned returns to the OR for a related complication require modifier 78. NCCI edits are active for this code family — billing 26480 alongside certain wrist arthroplasty or CMC suspension codes on the same day has been flagged as an edit conflict; review PTP edits before submitting same-day combinations.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	8.78
Practice expense RVU	9.56
Malpractice RVU	1.66
Total RVU	20
Medicare national rate	$668.02
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	$668.02
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 26480 get rejected.

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

Free graft obtained but 26480 billed instead of 26483 — payer downcodes or denies based on operative note review
Same-day NCCI PTP conflict when bundled with CMC arthroplasty or suspension codes without a valid modifier
Missing laterality modifier (LT or RT) required by payer — common with commercial plans and some MACs
Tendon transfer documented in the palm or fingers rather than the CMC area or dorsum, mismatching code to anatomy
Insufficient diagnosis linkage — ICD-10 code doesn't support functional tendon deficit requiring transfer (e.g., only a sprain diagnosis submitted)

Frequently asked questions

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

01What's the difference between 26480 and 26483?

26480 is used when the tendon is transferred using tissue already present at the operative site — no graft harvested. 26483 applies when a free tendon graft is obtained from a separate donor site and used to complete the transfer. The operative note must explicitly state no graft was taken to support 26480.

02Can 26480 be billed multiple times on the same date for multiple tendons?

Yes. The code is defined 'per tendon.' Each additional tendon transferred at the same session is billed as a separate line with modifier 51 appended to the secondary unit. Document each tendon by name in the operative report.

03Does 26480 have a bilateral modifier scenario?

Rarely, but yes — modifier 50 applies if the same tendon transfer is performed on both hands during the same operative session. Most cases are unilateral; use LT or RT for standard unilateral procedures where the payer requires laterality.

04Can I bill 26480 with a CMC arthroplasty on the same day?

NCCI PTP edits create conflicts between 26480 and certain CMC-related codes. Before submitting, verify the specific code pair in the CMS NCCI tool. If the tendon transfer is a distinct procedure with a separately documented indication, modifier 59 or XS may override the edit — but the operative note must support it. An AAPC forum case flagged exactly this combination (EPB-to-APL with CMC suspension arthroplasty) as a bundling issue.

05What ICD-10 codes typically pair with 26480?

Common supporting diagnoses include tendon rupture of the hand (M66.34x), radial nerve palsy (G54.2, G56.3x), CMC joint instability or arthritis (M18.x), and acquired deformity of the hand (M20.0x). The diagnosis must document a functional deficit that justifies surgical tendon rerouting — a sprain code alone will not support the procedure.

06What happens if the surgeon returns to the OR within the 90-day global to address a complication from the tendon transfer?

Use modifier 78 for an unplanned return to the OR for a procedure directly related to the original transfer (e.g., tendon rupture at repair site, adhesion lysis). Use modifier 79 only if the return procedure is entirely unrelated to the original surgery.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures the tendon name, anatomic zone (CMC area vs. dorsum vs. palm), graft status (none used), fixation technique, and per-tendon count from your dictation. That detail prevents the two most common denials: upcoding to 26483 when no graft was taken, and NCCI conflicts from ambiguous same-day procedure documentation. Laterality is flagged automatically so LT/RT is never missing on submission.

See how Mira captures CPT 26480 documentation