Tendon transfer surgery that restores intrinsic muscle function across all four fingers, correcting claw hand deformity caused by intrinsic muscle paralysis or loss.

Verified May 8, 2026 · 6 sources ↓

Medicare: $1,119.93
Total RVUs: 33.53
Global, days: 90
Region: Hand

Drawn from CMSAAPCBeonbrandEatonhandCgsmedicare

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Identify the specific donor tendon(s) harvested and the anatomic source (e.g., flexor digitorum superficialis, extensor indicis proprius)
Describe the routing path of each transferred tendon — dorsal interosseous, through lumbrical canal, or around radial/ulnar border
Document intraoperative tension setting and the position of the fingers at time of fixation
Record the underlying diagnosis driving intrinsic loss — ulnar nerve palsy, combined nerve injury, trauma, or other — with corresponding ICD-10
Note all four fingers addressed to support the all-finger descriptor; a note covering fewer fingers does not support 26498
Include pre-operative functional assessment documenting MCP hyperextension and IP flexion deformity

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 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 26498 covers a tendon transfer procedure designed to restore intrinsic function to all four fingers simultaneously. Intrinsic muscle loss causes the classic claw hand pattern: hyperextension at the metacarpophalangeal joints combined with flexion at the proximal and distal interphalangeal joints. The surgeon reroutes donor tendons — typically from extrinsic motors with expendable function — through or around the hand to replicate the lumbrical/interosseous pull that would normally flex the MCPs and extend the IPs. Because this is an all-four-finger procedure, 26498 is distinct from single- or partial-finger transfers coded elsewhere in the 26490–26497 range.

The 90-day global period means the operative fee covers the day-before visit, the surgery itself, and all routine post-op management through day 90. Therapy visits are separately billable; staged or unrelated procedures in the global window require modifier 79. If a complication demands an unplanned return to the OR for a related reason, bill modifier 78.

Non-Medicare payers vary on prior authorization requirements and medical necessity thresholds for tendon transfers — document the functional deficit, failed conservative management where applicable, and the neurologic or traumatic etiology driving intrinsic loss. Operative notes that omit which donor tendon was harvested, the routing path, and intraoperative tension-setting are the most common audit triggers for this code.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	13.85
Practice expense RVU	16.73
Malpractice RVU	2.95
Total RVU	33.53
Medicare national rate	$1,119.93
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	$1,119.93
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 26498 get rejected.

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

Operative note documents transfer to fewer than all four fingers — payers interpret this as a lesser code (26490–26497 range)
Missing or vague ICD-10 linkage; intrinsic loss must be tied to a specific neurologic or traumatic diagnosis, not an unspecified hand condition
NCCI bundling conflict when 26497 is billed same-day as 26498 — 26497 is a component code per CCI edits
Prior authorization not obtained for elective tendon transfer reconstructions, particularly on commercial plans
Insufficient documentation of failed conservative management or functional deficit severity for medical necessity review

Frequently asked questions

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

01Can 26498 and 26497 be billed together on the same date?

No. Per CCI edits effective through the current version, 26497 is a component code of 26498 and will be denied when billed together. Report only 26498 when all four fingers are addressed in a single operative session.

02What modifier applies if the surgeon returns to the OR during the 90-day global to address a complication of the tendon transfer?

Use modifier 78 for an unplanned return to the OR for a complication directly related to the original tendon transfer. Modifier 79 applies only when the return procedure is unrelated to the index surgery.

03Does 26498 cover fewer than four fingers if that's all the surgeon transferred?

No. The descriptor requires all four fingers. If the transfer covered one, two, or three fingers, the correct code is from the 26490–26497 range. Upcoding to 26498 on a partial-finger transfer is an audit risk.

04Is modifier 50 appropriate for 26498?

Bilateral tendon transfers for intrinsic loss in both hands would use modifier 50, but this is clinically uncommon in a single operative session. Use LT/RT if payer policy requires anatomic side modifiers instead of 50.

05What ICD-10 codes typically support medical necessity for 26498?

Ulnar nerve palsy (G54.2, G56.2x series), combined median-ulnar nerve injury, and traumatic intrinsic muscle loss are the primary drivers. Unspecified hand deformity codes alone will invite medical necessity denials — be specific to the neurologic or traumatic etiology.

06How does the 90-day global affect post-operative hand therapy billing?

Therapy services (CPT 97110, 97530, etc.) provided by a separate therapist are not included in the surgical global and bill independently. What's bundled is the surgeon's own post-op office visits. Therapy by the operating surgeon's own staff may have different rules depending on incident-to billing policies.

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 and harvest site, the routing path through the hand, tension and fixation details, and the positions of all four fingers at closure — directly from the surgeon's dictation. That specificity prevents the most common audit flag for 26498: an operative note that says 'tendon transfer performed' without naming the motor, the route, or confirming all four fingers were addressed.

See how Mira captures CPT 26498 documentation