Tendon transfer to restore intrinsic function of the ring and small fingers by rerouting a donor tendon to replace lost intrinsic muscle function.

Verified May 8, 2026 · 6 sources ↓

Medicare: $879.78
Total RVUs: 26.34
Global, days: 90
Region: Hand

Drawn from CMSEmednyFastrvuEatonhandCgsmedicare

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 transfer — specify nerve injury, paralysis etiology, or intrinsic weakness with muscle testing findings
Identification of the donor tendon used and its harvest site
Description of the routing path and insertion point for the transferred tendon
Intraoperative confirmation of adequate tension and passive range of motion after transfer
Laterality documented explicitly — left, right, or bilateral — matched to claim modifiers
Failed conservative management or neuromuscular workup supporting surgical indication

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 24 Unrelated E/M during global 25 Significant separate E/M 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 58 Staged or related 59 Distinct service 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 26497 covers surgical transfer of a tendon to restore intrinsic function specifically to the ring and small fingers. This procedure addresses intrinsic muscle paralysis or weakness — most often from ulnar nerve injury — where the lumbricals and interossei can no longer control MCP flexion and IP extension. The surgeon reroutes a donor tendon (commonly the flexor digitorum superficialis) through the hand to replicate that intrinsic action.

The 90-day global period applies. All routine post-op visits, dressing changes, and splint management through day 90 are bundled. Any visit unrelated to the tendon transfer in that window requires modifier 24; a separately identifiable E/M on the day of surgery requires modifier 25.

When the same transfer is performed on both hands at the same operative session, append modifier 50 and bill one line. If you're also billing 26498 (all four fingers) at the same encounter, expect an NCCI edit — document distinct anatomic indications and apply modifier 59 or XS only if clinically supported. Per NCCI policy, finger procedures should carry digit-specific modifiers (F1–F9) when the same code is billed for multiple fingers; MUE values for many finger procedure codes are set at one per the use of these modifiers.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	9.52
Practice expense RVU	14.78
Malpractice RVU	2.04
Total RVU	26.34
Medicare national rate	$879.78
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	$879.78
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 26497 get rejected.

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

Missing or vague diagnosis — 'finger weakness' without a nerve injury or neuromuscular diagnosis code fails medical necessity review
Digit modifier absent when the same code is billed for more than one finger on the same date
26497 and 26498 billed together without modifier 59 or XS and supporting documentation of distinct anatomic indications
Routine post-op visit billed without modifier 24 inside the 90-day global period
Bilateral procedure billed on two separate lines instead of one line with modifier 50

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01What is the difference between CPT 26497 and 26498?

26497 covers tendon transfer to restore intrinsic function to the ring and small fingers only. 26498 covers all four fingers. Bill 26498 when the transfer addresses index through small finger; bill 26497 when only the ring and small are treated.

02Do I need a digit modifier (F1–F9) for 26497?

NCCI policy directs digit-specific modifiers for finger procedures when the same code is billed for more than one finger. If you're billing 26497 once for the ring-and-small finger unit as described, document laterality with LT or RT. If the same code appears on the claim for an additional distinct finger, use the appropriate F-modifier to avoid an MUE edit.

03Can I bill an E/M visit on the same day as the 26497 surgery?

Only if the E/M represents a significant, separately identifiable service unrelated to the decision to operate. Append modifier 25 to the E/M. The decision-for-surgery visit the day before uses modifier 57.

04What modifier applies if I need to take the patient back to the OR for a complication related to the tendon transfer?

Modifier 78 — unplanned return to the operating room for a procedure related to the original surgery during the global period. If the return procedure is unrelated to the tendon transfer, use modifier 79 instead.

05Is 26497 typically performed in an ASC or hospital outpatient setting, and does it affect payment?

Both settings are used. HOPD and ASC payments differ materially — see the Site of Service comparison table on this page. The surgeon's professional fee is the same regardless of site; the facility payment is what changes.

06What ICD-10 diagnoses support medical necessity for 26497?

Ulnar nerve injury or palsy (S54.0XX, G56.2), traumatic intrinsic muscle paralysis, and claw hand deformity (M21.51X) are the most common supporting diagnoses. Payers expect a specific etiology code — avoid unspecified weakness codes without a nerve or structural diagnosis.

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 donor tendon name, harvest site, routing path, insertion point, and intraoperative tension check directly from dictation. It also flags laterality and maps the nerve injury diagnosis to a specific ICD-10 code. This prevents the two most common denials for 26497: a vague operative note that can't satisfy medical necessity review and a missing or mismatched digit modifier.

See how Mira captures CPT 26497 documentation