Opponensplasty using hypothenar muscle transfer to restore thumb opposition in the hand.
Verified May 8, 2026 · 6 sources ↓
- Medicare
- $824.00
- Total RVUs
- 24.67
- 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 6 cited references ↓
- Diagnosis driving the procedure — specify etiology (median nerve palsy, traumatic, congenital) and duration of opposition deficit
- Named donor muscle or tendon used (e.g., abductor digiti minimi), with description of its origin, detachment, and new insertion point
- Operative note must document the routing path of the transfer and fixation method at the thumb insertion
- Laterality explicitly stated — left or right hand — in both the operative note and the procedure order
- Pre-operative functional assessment documenting loss of thumb opposition, including provocative exam findings or nerve conduction study results if applicable
- Any concurrent procedures performed in the same operative session listed separately with independent documentation supporting each
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 6 cited references ↓
CPT 26494 describes an opponensplasty performed via hypothenar muscle transfer — a reconstructive hand procedure that reroutes intrinsic muscle to restore thumb opposition. Opposition is the thumb's ability to rotate and meet the other digits; loss of it is functionally devastating. The hypothenar transfer variant uses the abductor digiti minimi or flexor digiti minimi, detaching and rerouting the muscle to the thumb's extensor-abductor mechanism. It sits within the opponensplasty family (26490–26496), distinguished from the superficialis tendon transfer type (26490), the tendon transfer with graft type (26492), and other methods (26496).
The 90-day global period covers all routine post-op hand therapy visits, dressing changes, and splint checks through day 90. Any unrelated procedure in that window requires modifier 79. A staged reconstructive procedure — for example, tenolysis or pulley reconstruction performed after the primary transfer heals — uses modifier 58 if planned, or 78 if the return was unplanned and related. Laterality modifiers LT and RT are essential; most payers auto-deny hand surgery claims that omit them.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 8.44 |
| Practice expense RVU | 14.44 |
| Malpractice RVU | 1.79 |
| Total RVU | 24.67 |
| Medicare national rate | $824.00 |
| 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 | $824.00 |
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 26494 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Missing laterality modifier (LT or RT) — most hand surgery payers auto-deny without it
- Medical necessity not established — documentation lacks objective evidence of opposition deficit or failed conservative management
- Unbundling conflict when concurrent tendon procedures are billed without modifier 51 or without distinct operative documentation
- Global period conflict — post-op visit billed without modifier 24 when unrelated to the transfer, triggering automatic denial
- Wrong opponensplasty code selected — payers audit 26494 versus 26490 and 26492; operative note must match the specific transfer technique billed
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 6 cited references ↓
01What distinguishes 26494 from 26490 and 26492?
02Do I need a surgical assistant modifier for 26494?
03Can I bill 26494 bilaterally on the same date?
04What modifier applies if I need to return to the OR within the 90-day global for a related complication?
05Is 26494 payable in an ASC setting?
06When is modifier 22 justified for 26494?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02mdclarity.comhttps://www.mdclarity.com/cpt-code/26494
- 03aapc.comhttps://www.aapc.com/codes/cpt-codes/26494
- 04abos.orghttps://www.abos.org/wp-content/uploads/2019/12/hand-cpt-updated.pdf
- 05ebhmc.comhttps://ebhmc.com/cpt/
- 06eatonhand.comhttps://www.eatonhand.com/coding/n26494.htm
Mira AI Scribe
Mira's AI scribe captures the donor muscle name, routing path, and thumb insertion technique directly from operative dictation — the three elements auditors check first when differentiating 26494 from 26490 or 26492. It also flags laterality in real time so LT or RT is appended before the claim leaves the chart, preventing the single most common auto-denial on hand surgery claims.
See how Mira captures CPT 26494 documentation