Cross intrinsic transfer procedure redirecting a tendon from one side of a finger to the other to correct ulnar drift, billed per tendon transferred.

Verified May 8, 2026 · 7 sources ↓

Medicare: $627.60
Work RVU: 5.46
Global, days: 90
Region: Hand

Drawn from CMSFastrvuAAPCEmednyEatonhand

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Specify the diagnosis driving the procedure — rheumatoid arthritis, other inflammatory arthropathy, or alternative etiology — with supporting ICD-10 code
Identify each tendon transferred by name and the specific finger(s) involved, with the direction of transfer documented (e.g., ulnar to radial lateral band)
Record the number of tendons transferred — reimbursement is per tendon, and units must match the operative note count exactly
Describe preoperative deformity severity, including degree of ulnar drift or MCP subluxation, to support medical necessity
Document any concurrent procedures (e.g., MCP arthroplasty, synovectomy) in separate operative note sections to support unbundling if applicable
Include intraoperative findings — tendon quality, joint condition, absence or presence of active synovitis — particularly relevant for rheumatoid cases

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 51 Multiple procedures 59 Distinct service 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 26510 describes a cross intrinsic transfer — a surgical procedure in which an intrinsic muscle tendon is rerouted from the ulnar side of a finger to the radial side (or vice versa) to counteract the characteristic ulnar deviation seen in rheumatoid arthritis and other conditions causing metacarpophalangeal joint deformity. The code is reported per tendon, so if multiple fingers are corrected in a single operative session, each tendon transfer is counted separately.

The 90-day global period means all routine postoperative care, splint checks, suture removal, and therapy coordination visits are bundled through day 90. Separate E/M services during this window require modifier 24 to document an unrelated problem, or modifier 25 if a significant, separately identifiable service occurs on the day of the procedure itself. New complications or unplanned returns to the OR for a related issue use modifier 78; an unrelated same-period surgical procedure uses modifier 79.

Because rheumatoid patients frequently undergo concurrent MCP arthroplasties (26530/26531) and soft tissue reconstructions at the same operative session, NCCI bundling review is essential before submitting. Verify each procedure has its own distinct operative documentation and that no column-one/column-two edits apply before appending modifier 59 or XS to unbundle. Coders should also confirm the number of tendons transferred matches the count in the operative note — a common audit trigger when units billed exceed what the documentation supports.

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 (5.46) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (18.79) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	5.46
Practice expense RVU	12.28
Malpractice RVU	1.05
Total RVU	18.79
Medicare national rate	$627.60
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	$627.60
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 26510 get rejected.

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

Units billed exceed tendons documented in the operative note — coders must reconcile the per-tendon count before submission
Medical necessity not established when pre-op imaging, clinical exam findings, or failed conservative treatment are absent from the record
Bundling edits triggered when concurrent hand procedures (e.g., MCP arthroplasty, capsulodesis) are billed without appropriate modifier to distinguish separate, distinct work
Missing or vague ICD-10 linkage — payers expect a specific rheumatoid or structural diagnosis code, not an unspecified hand deformity code
Global period violations when post-op office visits are billed without modifier 24 during the 90-day window

Frequently asked questions

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

01Is 26510 billed per finger or per tendon?

Per tendon. If you correct ulnar drift on three fingers in one session, bill 26510 with three units. Each tendon transferred must be individually documented in the operative note — payers will audit units against the dictation.

02Can 26510 be billed with MCP arthroplasty (26530 or 26531) on the same day?

Yes, but verify NCCI edits first. These procedures are often performed together in rheumatoid reconstruction cases. If an edit exists, you'll need modifier 59 or XS with documentation showing each procedure was distinct. Don't append the modifier without the operative note support.

03What modifier applies if the surgeon performs 26510 bilaterally?

Modifier 50 for a true bilateral procedure billed on a single claim line. If only one hand is treated, use LT or RT. Confirm your payer's bilateral payment policy — Medicare allows up to 150% of the single-procedure rate.

04What ICD-10 codes are typically paired with 26510?

Rheumatoid arthritis with hand involvement is the most common driver — look to M05 and M06 categories. Ulnar drift of fingers (M20.0x) is also frequently linked. Avoid unspecified deformity codes; payers expect specificity that maps to documented clinical findings.

05Does the 90-day global include post-op hand therapy coordination visits?

Routine post-op visits and splint checks are bundled in the global. If the surgeon provides a separately identifiable service unrelated to the original procedure during the 90-day period, bill with modifier 24. Therapy itself (when billed by a therapist) is outside the global and billed separately.

06When would modifier 22 apply to 26510?

When the procedure is substantially more complex than typical — for example, revision of a failed prior transfer in a heavily scarred field, or a case with severe joint destruction requiring significantly more operative time. Document the increased complexity explicitly in the operative note and expect payer review.

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 finger-level detail that makes or breaks a 26510 claim: which tendon was transferred, the direction of transfer, the number of tendons, and the concurrent procedures performed. It flags when the operative dictation references multiple tendons so the coder knows to bill multiple units — preventing the most common undercoding error on cross intrinsic transfer cases. It also tags any same-session arthroplasty or capsulodesis work for NCCI bundling review before the claim goes out.

See how Mira captures CPT 26510 documentation