Surgical reconstruction of a finger flexor tendon pulley using local tissues, billed per tendon as a separate procedure.

Verified May 8, 2026 · 7 sources ↓

Medicare: $687.06
Work RVU: 5.98
Global, days: 90
Region: Hand

Drawn from CMSAAPCNIHFindacodeEatonhand

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Identify the specific tendon(s) involved by name and digit — one unit per tendon, not per pulley
State the reconstruction material explicitly: local tissue, tendon/fascial graft, or prosthesis — material determines the correct code (26500 vs 26502 vs 26504)
Document pulley type and location (e.g., A1, A2, annular vs cruciate) and the clinical indication for reconstruction
If billing with a companion tendon procedure, document a separate operative indication justifying 26500 as a distinct service
For staged procedures within the 90-day global, document the planned staging and reference the original surgery date

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 51 Multiple procedures 58 Staged or related 59 Distinct service 76 Repeat, same physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 26500 covers reconstruction of a flexor tendon pulley — the annular or cruciate ring structures that keep flexor tendons tracking against the bone — using only local tissue from the operative field. It carries a 90-day global period and is designated a separate procedure, meaning it bundles into more comprehensive hand surgery when performed as part of a larger reconstruction. Bill it per tendon involved, not per pulley: if the A1 and A2 pulleys of a single tendon are both reconstructed, that is one unit of 26500.

Code selection within the 26500 series turns on the graft material used. Local tissues only = 26500. Tendon or fascial graft (including harvest) = 26502. Artificial tendon prosthesis = 26504. Getting that distinction wrong is the most common miscoding pattern in pulley reconstruction billing. Confirm the operative note specifies the reconstruction material before assigning any code in this series.

Because 26500 is a separate procedure, payers will bundle it when it accompanies a more comprehensive tendon procedure on the same digit unless a distinct operative indication is documented and modifier 59 or XS is appended. The 90-day global also means staged procedures — Hunter rod placement followed by pulley reconstruction — require modifier 58 to break out the second surgery for payment.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU vs. total RVU

The work RVU (5.98) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (20.57) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	5.98
Practice expense RVU	13.31
Malpractice RVU	1.28
Total RVU	20.57
Medicare national rate	$687.06
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	$687.06
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI A2) Ambulatory surgical center (freestanding)	$3,695.53

Common denial reasons

The recurring reasons claims for CPT 26500 get rejected.

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

Bundling into a companion tendon procedure (e.g., tenolysis or tendon repair on the same digit) without modifier 59 or XS to establish a distinct service
Billing multiple units for multiple pulleys on the same tendon — code is per tendon, not per pulley
Wrong code selection when graft material is tendon, fascia, or prosthesis — those procedures require 26502 or 26504, not 26500
Staged second-surgery claim denied because modifier 58 was omitted during the 90-day global of a prior related procedure
Missing laterality documentation when bilateral reconstruction is performed — modifier 50 or RT/LT required

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01If the surgeon reconstructs the A1 and A2 pulleys on the same finger, how many units of 26500 do I bill?

One unit. The code is per tendon, not per pulley. Both pulleys on the same flexor tendon = one unit of 26500.

02When should I use 26502 instead of 26500?

Use 26502 when the surgeon used a tendon or fascial graft — including harvesting that graft — rather than local tissue only. The operative note must state the reconstruction material clearly. If it does not, query the surgeon before coding.

03Can I bill 26500 alongside a flexor tendon repair or tenolysis on the same digit?

26500 is a separate procedure, so it will bundle with a more comprehensive tendon procedure on the same digit by default. Append modifier 59 or XS only if the pulley reconstruction was performed for a distinct clinical indication that is separately documented in the operative note.

04The surgeon is doing a staged Hunter rod procedure followed by pulley reconstruction during the global period. How do I code the second surgery?

Append modifier 58 to 26500 (or the applicable code in the series) on the second claim. Modifier 58 signals a planned staged procedure within the global, distinguishing it from an unplanned related return (modifier 78).

05What modifiers do I need for bilateral pulley reconstruction billed on the same date?

Append modifier 50 for bilateral billing, or use LT and RT on separate line items depending on payer preference. Confirm laterality documentation in the operative note supports the bilateral claim before submission.

06Does 26500 have a global period, and what does it cover?

Yes — 26500 carries a 90-day global period. That includes the day before surgery, the operative day, and all routine post-op visits through day 90. Unrelated E/M services in that window need modifier 24; related E/M visits are bundled and not separately billable.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira Scribe

Mira's AI scribe captures the specific tendon name and digit, the pulley type and position (A1, A2, annular, cruciate), and the reconstruction material — local tissue, graft, or prosthesis — directly from the surgeon's dictation. That detail drives code selection across the 26500 series and prevents the single most common miscoding pattern in pulley reconstruction: landing on 26500 when the note actually supports 26502 or 26504.

See how Mira captures CPT 26500 documentation