Reconstruction of a finger tendon pulley using a harvested tendon or fascial graft, billed per tendon treated.

Verified May 8, 2026 · 6 sources ↓

Medicare: $745.17
Work RVU: 7.13
Global, days: 90
Region: Hand

Drawn from CMSAAPCFindacodeEatonhandAbos

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 pulley(s) reconstructed by name and location (e.g., A2, A4) and the finger involved.
Specify the graft type — tendon graft versus fascial graft — and document the harvest site and technique.
State the surgical indication, including mechanism of injury or pathology causing pulley insufficiency.
Document the tendon involved, since 26502 is billed per tendon, not per pulley — the note must make the tendon count clear.
If multiple tendons on the same or different fingers are reconstructed, document each tendon separately to support billing 26502 per tendon.
Confirm that graft harvest was performed by the same surgeon in the same session if inclusion of harvest is relied upon to avoid a separate harvest code.

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 58 Staged or related LT Left side RT Right side 80 Assistant surgeon AS PA/NP/CNS assistant

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

26502 covers reconstruction of a finger flexor tendon pulley — the annular or cruciate ring structure that keeps the flexor tendon bowstringing-free during digital motion — when the surgeon uses a tendon or fascial graft rather than local tissue. Graft harvest is included; don't bill a separate harvest code. The descriptor reads 'each tendon,' not each pulley, so if the A2 and A4 pulleys of a single tendon are both reconstructed in the same session, you still report 26502 once for that tendon.

Code selection within the 26500 series turns entirely on technique: local tissue reconstruction goes to 26500, graft-based reconstruction to 26502, and prosthetic reconstruction to 26504. Misidentifying the technique in the operative note — or leaving it vague — is the fastest path to a denial or a mismatch between the op note and the billed code.

The 90-day global period means all routine post-op care through day 90 is bundled. If a separate, unrelated procedure is performed during that window, append modifier 79. For a staged or planned related procedure in the global period, use modifier 58. NCCI bundles should be checked before pairing 26502 with same-session tendon repair codes such as 26356.

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 (7.13) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (22.31) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	7.13
Practice expense RVU	13.68
Malpractice RVU	1.5
Total RVU	22.31
Medicare national rate	$745.17
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	$745.17
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 26502 get rejected.

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

Operative note does not specify graft type, making it impossible to distinguish 26502 from 26500 (local tissue) or 26504 (prosthesis).
Code billed per pulley rather than per tendon, resulting in unit count mismatches against the MUE.
Same-session tendon repair code (e.g., 26356) billed without checking NCCI bundling, triggering an edit.
Graft harvest billed separately when the 26502 descriptor already includes obtaining the graft.
Post-op visit billed without modifier 24 or 25 inside the 90-day global period, causing automatic denial.

Frequently asked questions

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

01Can I bill 26502 twice if the surgeon reconstructed two pulleys on the same tendon?

No. The descriptor is 'each tendon,' not each pulley. Two pulleys on one tendon = one unit of 26502. Two tendons on the same finger would support two units, but document each tendon explicitly.

02What's the difference between 26500, 26502, and 26504?

Technique drives the code: local tissue only = 26500; tendon or fascial graft = 26502; artificial tendon prosthesis = 26504. The operative note must name the material used or any of these codes is unsupported.

03Is graft harvest separately billable when using 26502?

No. The descriptor explicitly includes obtaining the graft. Billing a separate harvest code alongside 26502 will be bundled or denied.

04Can 26502 be billed same-day with a flexor tendon repair like 26356?

Check NCCI edits first — the combination can trigger a bundling edit. If both procedures are separately identifiable and not bundled, modifier 59 or XS may be needed with supporting documentation.

05What modifier applies if a related procedure is performed during the 90-day global?

Modifier 58 for a staged or planned related procedure. Modifier 78 for an unplanned return to the OR for a complication related to the original procedure. Modifier 79 only for a genuinely unrelated procedure.

06Does site of service affect reimbursement for 26502?

Yes. HOPD and ASC payments differ significantly — see the Site of Service comparison table on this page. The facility captures the facility fee; the surgeon's professional component is the same regardless of setting.

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 pulley name and number (e.g., A2, A4), the finger and hand laterality, the graft material and harvest site, and the tendon involved — all from surgeon dictation. That detail prevents the most common 26502 audit flag: an operative note that says 'pulley reconstruction with graft' without specifying technique, anatomy, or tendon count, which reviewers treat as insufficient to distinguish 26502 from 26500 or 26504.

See how Mira captures CPT 26502 documentation