CPT code 26442: Flexor tenolysis, palm and finger, with free graft2026 Medicare rate & RVUs in Missouri
Reports secondary release of adhesions limiting flexor tendon glide in the palm or finger when the procedure includes a free tendon graft.
CMS doesn’t publish an office rate for 26442 in Missouri.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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What 26442 covers
This procedure addresses a flexor tendon in the palm or finger that remains tethered by scar tissue and cannot glide adequately, often after an earlier tendon injury or repair. The surgeon frees the tendon and uses a free tendon graft as part of the secondary reconstruction. Hand surgeons typically perform it in an operating room, with the operative report identifying the involved tendon, adhesion release, and graft work.
Report 26442 for the secondary flexor tenolysis with free graft; 26440 is the related choice for flexor tenolysis without that graft work. The record should support the affected tendon, the adhesions restricting excursion, and the graft used. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this service, and 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 26442 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | Unavailable | $924.04 |
| Metropolitan St. Louis, MO | Unavailable | $933.14 |
| Rest of Missouri | Unavailable | $879.05 |
How the 26442 rate is calculated
Each of 26442’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 · 26442
RVUs × geographic indexes × conversion factor
Work9.51
9.51 RVUs× 1.000 GPCI
Practice expense17.42
17.42 RVUs× 1.000 GPCI
Malpractice1.84
1.84 RVUs× 1.000 GPCI
Adjusted RVUs
28.7700
Conversion factor
$33.4009
Medicare rate
$960.94
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 26442
26442 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 26442
Flexor tenolysis, palm and finger, with free graft
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.69/0.21 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 26442
Flexor tenolysis, palm and finger, with free 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.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
26442 without 51 · national facility
$960.94
Flexor tenolysis, palm and finger, with free graft
26442-51 · Second procedure: 50%
$480.47
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%).
26442 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 26440Flexor tenolysisPalm and finger
- Both address flexor tendon adhesions in the palm and finger. Choose 26442 when secondary tenolysis includes a free tendon graft; 26440 is the choice without that graft work.
- 26445Tendon releaseExtensor, hand or finger
- This code is for extensor tendon tenolysis in the hand or finger. Code 26442 concerns flexor tendon tenolysis with a free graft.
- 26449Tendon releaseExtensor tendon, forearm or wrist
- This code addresses extensor tendon tenolysis involving the forearm or hand, rather than the palm-and-finger flexor tendon procedure reported with 26442.
- 26416Tendon graftHand or finger
- Use 26416 for hand or finger tendon grafting when graft reconstruction is the service performed; 26442 describes secondary flexor tenolysis with a free graft.
26442 billing questions
How does 26442 differ from 26440?
Both concern flexor tendon tenolysis in the palm and finger. Use 26442 for the secondary procedure with a free tendon graft; use 26440 for tenolysis without that graft work.
Is the free tendon graft separately reported?
The graft is part of the service described by 26442. Document the graft and its role in the secondary tendon procedure.
Can modifier 50 be used for procedures on both hands?
No. CMS identifies modifier 50 as inappropriate for this code.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
How are other procedures in the same session paid?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%.
Is an assistant surgeon or co-surgeon payable?
Medicare does not pay an assistant at surgery for 26442. 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
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