Surgical correction of claw finger deformity using a technique not described by a more specific code, such as rerouting a flexor tendon to function as an extensor.
Verified May 8, 2026 · 6 sources ↓
- Medicare
- $850.39
- Total RVUs
- 25.46
- 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 ↓
- Identify the specific digit(s) treated and whether unilateral or bilateral
- Name the surgical technique used and why it does not correspond to a more specific code (26490–26498)
- Document the tendon(s) involved, including donor tendon source and recipient attachment site
- State the underlying etiology of the claw deformity (e.g., ulnar nerve palsy, median nerve palsy, post-traumatic)
- Confirm pre-operative clinical findings supporting the deformity and functional deficit
- Record intraoperative findings including tendon condition, excursion, and any graft harvest if applicable
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 26499 covers claw finger correction performed by methods that don't map to any more specific code in the 26490–26498 range. The classic technique involves transposing a flexor tendon from the palmar surface to the lateral aspect of the finger so it acts as an intrinsic extensor — restoring the lost lumbrical or interosseous function that drives the metacarpophalangeal flexion and interphalangeal extension pattern lost in claw deformity. Other reconstructive approaches that don't fit a named procedure code also fall here.
The code sits at the end of the opponensplasty and intrinsic-transfer series (26490–26498). If you performed a ring-and-small-finger intrinsic transfer, bill 26497. All four fingers, bill 26498. When the technique is truly outside those descriptors — or involves a single finger not covered by 26497/26498 — 26499 is the correct landing spot. Attempting to force the work into a more specific code to avoid unlisted scrutiny is a coding error, not a shortcut.
The 90-day global period covers all routine post-op management, dressing changes, splint checks, and therapy coordination visits through day 90. Any service unrelated to the claw finger repair performed during that window requires modifier 24 (E/M) or 79 (surgery). A return to the OR for a complication of this repair uses modifier 78. Document the specific tendon(s) involved, the technique by name, digit(s) treated, and the underlying etiology (ulnar nerve palsy, median nerve palsy, etc.) — payers auditing 26499 look for all of these.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 8.94 |
| Practice expense RVU | 14.61 |
| Malpractice RVU | 1.91 |
| Total RVU | 25.46 |
| Medicare national rate | $850.39 |
| 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 | $850.39 |
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 26499 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Insufficient documentation to justify use of 26499 over a more specific intrinsic-transfer code (26497/26498)
- Missing laterality modifier (LT or RT) when payer requires digit-level specificity
- Bundling with same-session tendon transfer codes without a supported distinct-service modifier
- Lack of documented clinical diagnosis linking ICD-10 to claw deformity requiring surgical correction
- Global period violation — post-op E/M billed without modifier 24 during the 90-day window
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 6 cited references ↓
01When should I bill 26499 instead of 26497 or 26498?
02Do I need a laterality modifier on 26499?
03Can I bill 26499 more than once if I corrected multiple fingers on the same hand?
04What ICD-10 codes typically pair with 26499?
05How does the 90-day global period affect post-op hand therapy coordination?
06Is 26499 performed in an ASC or hospital outpatient setting?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02aapc.comhttps://www.aapc.com/codes/cpt-codes/26499
- 03abos.orghttps://www.abos.org/wp-content/uploads/2019/12/hand-cpt-updated.pdf
- 04cms.govhttps://www.cms.gov/files/document/01-chapter1-ncci-medicare-policy-manual-2025finalcleanpdf.pdf
- 05novitas-solutions.comhttps://www.novitas-solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00085606
- 06eatonhand.comhttps://www.eatonhand.com/coding/n26499.htm
Mira AI Scribe
Mira's AI scribe captures the technique name, specific digit(s) treated, tendon donor and recipient sites, and the underlying neurological or traumatic etiology from the surgeon's dictation. It flags when the described technique overlaps with 26497 or 26498 descriptors, preventing a miscoded claim that auditors routinely challenge on 26499 submissions.
See how Mira captures CPT 26499 documentation