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CPT code 26449: Tendon release, extensor tendon, forearm or wrist2026 Medicare rate & RVUs

Surgical freeing of an extensor tendon in the forearm or wrist from adhesions that restrict its glide, reported for each tendon treated.

CMS RVU26DEffective Oct 1, 2026109 payment localities427 Medicare services in 2024

Medicare pays $660.67 for 26449 nationally in a facility.

Medicare rate · 26449

Tendon release, extensor tendon, forearm or wrist

Office or facility?

Work RVUs
8.38
Total RVUs
19.78
Global days
090

National rate · 2026

$660.67

Facility setting, before claim adjustments.

See every locality for 26449 →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 26449 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 26449 covers

This procedure frees an extensor tendon in the forearm or wrist from scar adhesions that limit tendon excursion and impair movement. A hand or orthopedic surgeon typically performs it when examination and operative findings support adhesions as the source of restricted tendon glide, such as after prior injury or tendon surgery. The work is tenolysis: freeing the tendon, rather than repairing, lengthening, or removing it.

Report the code for each extensor tendon treated, with documentation identifying the tendon and forearm or wrist location, the adhesions and functional restriction, and the release performed. It 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 the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple procedure reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment requires documented medical necessity; 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 26449 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

26449 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$596.97
AlaskaUnavailable$798.59
ArizonaUnavailable$642.98
ArkansasUnavailable$589.06
Atlanta, GAUnavailable$677.24
Austin, TXUnavailable$674.35
Bakersfield, CAUnavailable$677.17
Baltimore area, MDUnavailable$701.49
Beaumont, TXUnavailable$627.39
Brazoria, TXUnavailable$648.49

26449 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
26449 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 26449 rate is calculated

Each of 26449’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 · 26449

RVUs × geographic indexes × conversion factor

Office or facility?

Work8.38

8.38 RVUs× 1.000 GPCI

Practice expense9.84

9.84 RVUs× 1.000 GPCI

Malpractice1.56

1.56 RVUs× 1.000 GPCI

Adjusted RVUs

19.7800

Conversion factor

$33.4009

Medicare rate

$660.67

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

Payment rules and modifiers for 26449

26449 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 26449

Tendon release, extensor tendon, forearm or wrist

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)0Not paid without supporting documentation.
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 · 26449

Tendon release, extensor tendon, forearm or wrist

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

26449 without 51 · national facility

$660.67

Tendon release, extensor tendon, forearm or wrist

26449-51 · Second procedure: 50%

$330.34

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

26449 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 26449

    Tendon release, extensor tendon, forearm or wrist8.38 wRVU

    Not priced

  • 26445

    Tendon release, extensor, hand or finger4.34 wRVU

    Not priced

  • 26440

    Flexor tenolysis, palm and finger5.03 wRVU

    Not priced

  • 26476

    Tendon lengthening, hand or finger5.22 wRVU

    Not priced

How to choose

26445Tendon releaseExtensor, hand or finger
Choose 26449 for extensor tendon adhesions in the forearm or wrist; choose 26445 when the release is in the hand or finger.
26440Flexor tenolysisPalm and finger
This code concerns an extensor tendon in the forearm or wrist. Code 26440 describes flexor tendon tenolysis in the palm or finger.
26476Tendon lengtheningHand or finger
Tenolysis frees adhesions restricting tendon glide; 26476 is used for tendon lengthening, not simply freeing an adherent tendon.

Codes related to 26449

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

Codes related to 26449
CodeHow it relatesNational office range
Same family
26445Tendon release, extensor, hand or fingerExtensor tendon tenolysis in the hand or finger rather than the forearm or wrist.No office rate
26442Flexor tenolysis, palm and finger, with free graftAdditional flexor tendon tenolysis in the palm or finger code series.No office rate
Used instead
26440Flexor tenolysis, palm and fingerTenolysis for a flexor tendon in the palm or finger, not a forearm or wrist extensor tendon.No office rate

26449 billing questions

How is 26449 distinguished from 26445?

Both describe extensor tendon tenolysis, but 26449 is for the forearm or wrist and 26445 is for the hand or finger. Use the documented site of the tendon release.

Is this code for a flexor tendon release?

No. This code is for an extensor tendon in the forearm or wrist. Flexor tendon tenolysis in the palm or finger is reported from a separate code series.

How many units should be reported?

Report each extensor tendon treated, supported by the operative documentation. Identify the tendon and its location rather than relying only on the number of incisions.

Can modifier 50 be used for bilateral treatment?

No. Modifier 50 is inappropriate for this code under the CMS bilateral rule.

What postoperative care is included?

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

When is assistant-at-surgery payment allowed?

Assistant-at-surgery payment is allowed only when medical necessity is documented. 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 26449PPRRVU2026_Oct_nonQPP.csv, line 2,600 (RVU26D)

Open CMS sourceHow we calculate rates

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