Palmar tendon transfer or transplant performed without a free tendon graft, billed per tendon.

Verified May 8, 2026 · 7 sources ↓

Medicare: $806.97
Total RVUs: 24.16
Global, days: 90
Region: Hand

Drawn from CMSFastrvuFindacodeGenhealthAAPC

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Specify palmar approach explicitly — dorsal or combined approaches change the code.
Identify the donor tendon by name and anatomical origin.
Identify the recipient site and describe routing path through the palm.
State that no free tendon graft was harvested or used.
Document the indication: tendon rupture, nerve palsy, or functional deficit by finger or ray.
Record each tendon transferred separately if billing multiple units.
Note intraoperative tension-setting and fixation method (suture technique, anchor, or bone tunnel).

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 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side 80 Assistant surgeon AS PA/NP/CNS assistant

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

26485 covers surgical relocation of a tendon within the palm — moving a functioning donor tendon to replace or augment a non-functioning one — without harvesting a free graft from a separate site. The code is reported per tendon, so multiple transfers in the same palm each require a separate unit (subject to modifier and MUE rules). The procedure addresses function loss from tendon rupture, nerve palsy, or injury where direct repair is no longer viable.

This is palmar-approach work only. If the incision and transfer occur on the dorsal side of the hand, 26480 applies instead. If a free tendon graft is incorporated, step up to 26489. Getting this distinction right in the operative note is the single most common audit trigger for this code family.

26485 carries a 90-day global period. All routine post-op management — splint checks, wound care, suture removal — is bundled through day 90. Hand therapy visits billed separately under the surgeon's NPI during the global need modifier 24 with supporting documentation that the service was unrelated to the surgical recovery, which is rarely defensible. Route therapy to the therapist's NPI instead.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	7.69
Practice expense RVU	15
Malpractice RVU	1.47
Total RVU	24.16
Medicare national rate	$806.97
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	$806.97
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 26485 get rejected.

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

Wrong code selected — 26480 billed when incision was palmar, or vice versa.
Missing documentation that no free graft was used, prompting downcoding or pend to 26489.
Multiple units denied because the operative note doesn't individually describe each tendon transfer.
Services billed during the 90-day global period without appropriate modifier or separate therapist NPI.
Laterality not specified when payer requires LT or RT for hand procedures.

Frequently asked questions

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

01What's the difference between 26480 and 26485?

26480 is for dorsal hand tendon transfers; 26485 is for palmar transfers. The approach documented in the operative note determines the code. If the note says 'standard approach' without naming it, expect an audit flag.

02When should I use 26489 instead of 26485?

Use 26489 when a free tendon graft is harvested from a separate site and incorporated into the transfer. 26485 is strictly for transfers without a free graft. Graft harvest changes both the code and the RVU significantly.

03Can I bill multiple units of 26485 for two tendons transferred in the same session?

Yes. The code is reported per tendon. Each transfer needs its own documented description in the operative note — donor, recipient, and routing — to support each unit. Apply modifier 51 on the second and subsequent units per payer instructions.

04How does the 90-day global period affect post-op billing?

All routine post-op care is bundled for 90 days. Hand therapy billed under the surgeon's NPI during the global is almost never defensible as unrelated. Bill therapy under the therapist's own NPI to avoid bundling issues entirely.

05Do I need LT or RT modifiers for 26485?

Medicare doesn't require laterality modifiers on hand procedure codes the way it does for paired organ codes, but many commercial payers do. Check your top payer contracts. When in doubt, append LT or RT to avoid a payer-specific edit.

06Is modifier 22 ever justified for 26485?

Yes, when the procedure required substantially more work than typical — for example, severe scarring from prior surgery, complex rerouting, or extensive adhesion release prior to transfer. Document time, complexity, and specific barriers in the operative note. A cover letter to the payer explaining the increased work is standard practice.

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 approach (palmar vs. dorsal), donor tendon name and origin, recipient site, routing path, fixation technique, and an explicit statement that no free graft was used. It flags each tendon transferred as a discrete event so multi-unit billing is supported line by line. This prevents the two most common denials for 26485: wrong-approach code selection and missing graft-status documentation.

See how Mira captures CPT 26485 documentation