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CPT code 26357: Flexor tendon repair, zone II, secondary, no graft2026 Medicare rate & RVUs

Reports secondary repair of a flexor tendon in finger zone II, without a free graft, when the surgeon addresses an earlier tendon injury.

CMS RVU26DEffective Oct 1, 2026109 payment localities94 Medicare services in 2024

Medicare pays $853.39 for 26357 nationally in a facility.

Medicare rate · 26357

Flexor tendon repair, zone II, secondary, no graft

Office or facility?

Work RVUs
10.73
Total RVUs
25.55
Global days
090

National rate · 2026

$853.39

Facility setting, before claim adjustments.

See every locality for 26357 →Billed by an NP, PA or therapist? →

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What 26357 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 26357 covers

This code is for secondary repair or advancement of a flexor tendon in zone II of a finger, without a free tendon graft. It is generally performed by a hand, orthopedic, or plastic surgeon in an operating room when the tendon injury is being treated as a secondary repair rather than a primary repair. The operative note should identify the affected tendon and finger, the zone, and the secondary nature of the repair. A repair that uses a free graft follows a different code path.

Report the code for each tendon repaired, with documentation supporting zone II, secondary repair, and the absence of a free graft. The service has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Bilateral adjustment is inappropriate. Assistant-at-surgery payment may be made; co-surgeons and team surgery are not permitted.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 26357 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

26357 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$767.99
AlaskaUnavailable$1,025.62
ArizonaUnavailable$829.44
ArkansasUnavailable$757.40
Atlanta, GAUnavailable$876.48
Austin, TXUnavailable$869.72
Bakersfield, CAUnavailable$870.64
Baltimore area, MDUnavailable$907.75
Beaumont, TXUnavailable$810.29
Brazoria, TXUnavailable$835.74

26357 rates by state

Office rate range in each state. Select a state to see its payment localities.

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Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
26357 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 26357 rate is calculated

Each of 26357’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

How the rate is built · 26357

RVUs × geographic indexes × conversion factor

Office or facility?

Work10.73

10.73 RVUs× 1.000 GPCI

Practice expense12.54

12.54 RVUs× 1.000 GPCI

Malpractice2.28

2.28 RVUs× 1.000 GPCI

Adjusted RVUs

25.5500

Conversion factor

$33.4009

Medicare rate

$853.39

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 26357

26357 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 26357

Flexor tendon repair, zone II, secondary, no graft

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)2Paid.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.69/0.21Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 26357

Flexor tendon repair, zone II, secondary, no graft

90-day global period ends

Dec 30, 2026

Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).

Visit on Oct 31, 2026

Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

26357 without 51 · national facility

$853.39

Flexor tendon repair, zone II, secondary, no graft

26357-51 · Second procedure: 50%

$426.70

When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).

When to use modifier 51

26357 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 26357

    Flexor tendon repair, zone II, secondary, no graft10.73 wRVU

    Not priced

  • 26358

    Hand tendon repair, repair or graft12.29 wRVU

    Not priced

  • 26352

    Tendon repair, secondary, without free graft7.67 wRVU

    Not priced

  • 26356

    Flexor tendon repair, secondary, without free graft9.32 wRVU

    Not priced

How to choose

26358Hand tendon repairRepair or graft
Both describe secondary zone II flexor tendon repair. Choose 26358 when the surgeon uses a free graft; this code is for repair without one.
26352Tendon repairSecondary, without free graft
26352 describes primary zone II repair without a free graft. This code applies when the repair is secondary.
26356Flexor tendon repairSecondary, without free graft
26356 describes primary zone II repair with a free graft. This code is for secondary repair without a free graft.

Codes related to 26357

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 26357
CodeHow it relatesNational office range
Same family
26358Hand tendon repair, repair or graftSecondary zone II flexor tendon repair when a free graft is used.No office rate
26352Tendon repair, secondary, without free graftPrimary zone II flexor tendon repair without a free graft.No office rate
26356Flexor tendon repair, secondary, without free graftPrimary zone II flexor tendon repair with a free graft.No office rate
26350Flexor tendon repair, primary, zones 1-2Primary flexor tendon repair outside zone II.No office rate

26357 billing questions

How does this differ from a primary flexor tendon repair?

This code is for a secondary repair in zone II. Use a primary-repair code when the procedure is documented as primary, selecting the code that matches the zone and graft use.

When is a graft code used instead?

Use the corresponding secondary-repair code when the surgeon uses a free tendon graft. This code describes secondary repair without a free graft.

How many units are reported when more than one tendon is repaired?

The code is reported for each tendon repaired. The operative report should identify the tendons treated and support the applicable zone and repair type.

Can modifier 50 be used for repairs on both hands?

No. CMS identifies bilateral adjustment as inappropriate for this code; the descriptor or anatomy makes modifier 50 unsuitable.

What postoperative care is included?

The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.

May an assistant or co-surgeon be reported?

Assistant-at-surgery payment may be made. Co-surgeons and team surgery are not permitted.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Show the CMS file lines behind this rate
RVUs for 26357PPRRVU2026_Oct_nonQPP.csv, line 2,578 (RVU26D)

Open CMS sourceHow we calculate rates

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