Palmar tendon transfer or transplant using a free tendon graft, including harvest of the graft, reported per tendon.

Verified May 8, 2026 · 5 sources ↓

Medicare: $940.57
Total RVUs: 28.16
Global, days: 90
Region: Hand

Drawn from CMSAbosAAPCMdclarity

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Specify anatomic location as palmar — documentation must distinguish palmar from dorsal/carpometacarpal to justify 26489 over 26483 or 26480.
Identify the specific tendon(s) transferred by name and zone.
Document the free tendon graft source, harvest technique, and graft length used.
Record the indication (e.g., tendon rupture, reconstruction after trauma, rheumatoid destruction) with supporting diagnosis codes.
Describe the transfer technique, tensioning method, and fixation used intraoperatively.
Note the number of tendons addressed — each tendon is a separately reportable unit under this code.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 58 Staged or related 59 Distinct service 78 Unplanned return — related 79 Unrelated during global 24 Unrelated E/M 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 5 cited references ↓

CPT 26489 describes a palmar tendon transfer or transplant in which the surgeon uses a free tendon graft — harvested during the same operative session — to restore function in the palm. The graft harvest is bundled into this code; do not separately report graft procurement (e.g., 20924) when it is integral to 26489. The code is reported per tendon, so multiple tendons addressed in the same palm require multiple units with modifier 51 appended to the additional tendon(s).

The critical distinction within the palmar tendon transfer family is graft use: 26485 covers palmar transfer without a free graft; 26489 applies when a free graft is required. Dorsally sited transfers belong to 26480 (without graft) or 26483 (with graft). Mismatch between location (palmar vs. dorsal) and graft use is a common coding error that triggers audits and downcoding.

26489 carries a 90-day global period. All routine postoperative management through day 90 is included. Unrelated procedures or E/M visits during that window require modifier 79 or 24, respectively. Staged procedures planned at the time of the original surgery use modifier 58.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	9.61
Practice expense RVU	16.5
Malpractice RVU	2.05
Total RVU	28.16
Medicare national rate	$940.57
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	$940.57
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 26489 get rejected.

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

Wrong code selected — 26483 billed instead of 26489 when the transfer is palmar, not dorsal.
Graft harvest billed separately (e.g., 20924) despite being bundled into 26489 per NCCI policy.
Multiple tendons reported without modifier 51 on the additional unit(s), triggering duplicate claim edits.
Diagnosis code does not support palmar tendon reconstruction — vague or non-specific ICD-10 causes medical necessity denial.
Global period violation — post-op E/M billed without modifier 24 within the 90-day window.

Frequently asked questions

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

01What separates 26489 from 26485?

Both are palmar tendon transfers. 26485 is used when no free graft is needed. 26489 applies when a free tendon graft is harvested and used — and that harvest is included in the code, not separately billable.

02Can I report 26489 and 26483 together on the same hand?

Yes, if distinct tendons are addressed — one palmar and one in the carpometacarpal or dorsal area. Append modifier 51 to the lower-valued code and document each tendon location clearly in the operative note.

03Is the graft harvest separately billable with 26489?

No. The code descriptor explicitly includes obtaining the graft. Billing 20924 or similar graft harvest codes alongside 26489 violates NCCI bundling rules and will be denied.

04How do I bill for multiple tendons in the same palm during one session?

Report 26489 for the first tendon, then 26489 again with modifier 51 for each additional tendon. Document each tendon by name in the operative note.

05What modifiers apply if I need to return to the OR during the 90-day global for a related complication?

Use modifier 78 for an unplanned return to the OR for a complication related to the original procedure. Modifier 79 is for an unrelated procedure during the global — do not invert these.

06Does site of service affect reimbursement significantly for 26489?

Yes. HOPD and ASC facility payments differ substantially — see the Site of Service comparison table on this page. The procedure is performed under general or regional anesthesia and is appropriate for both settings.

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, transfer direction (palmar), graft source, harvest details, and fixation method directly from dictation. This prevents the most common audit flag: operative notes that confirm a free graft was used but fail to document palmar location explicitly, which leads auditors to downcode to 26485 or crosswalk to 26483.

See how Mira captures CPT 26489 documentation