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CPT code 26450: Tendon tenotomy, flexor tendon in palm2026 Medicare rate & RVUs

Open division of a flexor tendon in the palm is reported when a hand surgeon treats a tendon-related contracture requiring release at that site.

CMS RVU26DEffective Oct 1, 2026109 payment localities206 Medicare services in 2024

Medicare pays $458.93 for 26450 nationally in a facility.

Medicare rate · 26450

Tendon tenotomy, flexor tendon in palm

Office or facility?

Work RVUs
3.7
Total RVUs
13.74
Global days
090

National rate · 2026

$458.93

Facility setting, before claim adjustments.

See every locality for 26450 →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 26450 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 26450 covers

This procedure involves surgically dividing a flexor tendon within the palm to reduce a tendon-related contracture or correct restricted finger position. A hand surgeon typically performs it in an operating room, with the operative report identifying the tendon and palm-level site and describing the reason for division. It differs from freeing a tendon from adhesions: tenotomy divides the tendon, while tenolysis releases tethering around it.

Report the code when the operative work is an open tenotomy of a flexor tendon in the palm, not when the tendon division is at the finger or involves an extensor tendon. Documentation should establish the treated tendon, the palm location, the indication, and the procedure performed. Medicare 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 are subject to the standard 50% 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 26450 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

26450 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$409.89
AlaskaUnavailable$530.67
ArizonaUnavailable$445.93
ArkansasUnavailable$403.72
Atlanta, GAUnavailable$468.93
Austin, TXUnavailable$474.66
Bakersfield, CAUnavailable$482.25
Baltimore area, MDUnavailable$489.17
Beaumont, TXUnavailable$429.19
Brazoria, TXUnavailable$452.04

26450 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
26450 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 26450 rate is calculated

Each of 26450’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 · 26450

RVUs × geographic indexes × conversion factor

Office or facility?

Work3.70

3.70 RVUs× 1.000 GPCI

Practice expense9.35

9.35 RVUs× 1.000 GPCI

Malpractice0.69

0.69 RVUs× 1.000 GPCI

Adjusted RVUs

13.7400

Conversion factor

$33.4009

Medicare rate

$458.93

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

Payment rules and modifiers for 26450

26450 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 26450

Tendon tenotomy, flexor tendon in palm

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 · 26450

Tendon tenotomy, flexor tendon in palm

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

26450 without 51 · national facility

$458.93

Tendon tenotomy, flexor tendon in palm

26450-51 · Second procedure: 50%

$229.47

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%).

When to use modifier 51

26450 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 26450

    Tendon tenotomy, flexor tendon in palm3.7 wRVU

    Not priced

  • 26455

    Tendon incision, open finger tenotomy3.67 wRVU

    Not priced

  • 26460

    Extensor tenotomy, hand or finger tendon3.49 wRVU

    Not priced

  • 26440

    Flexor tenolysis, palm and finger5.03 wRVU

    Not priced

How to choose

26455Tendon incisionOpen finger tenotomy
Choose 26450 for open flexor tendon division in the palm and 26455 when the division is at the finger.
26460Extensor tenotomyHand or finger tendon
26460 concerns an extensor tendon; 26450 concerns a flexor tendon in the palm.
26440Flexor tenolysisPalm and finger
26440 frees a flexor tendon from adhesions. Report 26450 when the palm-level flexor tendon itself is divided.

Codes related to 26450

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

Codes related to 26450
CodeHow it relatesNational office range
Same family
26455Tendon incision, open finger tenotomyOpen flexor tendon tenotomy at the finger rather than in the palm.No office rate
Used instead
26460Extensor tenotomy, hand or finger tendonOpen tendon incision involving an extensor tendon of the hand or finger.No office rate
26440Flexor tenolysis, palm and fingerFlexor tenolysis releases adhesions rather than dividing the tendon.No office rate

26450 billing questions

How is this distinguished from 26455?

This code is for open flexor tendon division in the palm. Code 26455 describes the corresponding tenotomy at the finger.

How is tenotomy different from tenolysis?

Tenotomy divides the tendon; tenolysis frees a tendon from adhesions that restrict its glide. Code 26440 is a nearby flexor tenolysis code.

Should modifier 50 be reported for both hands?

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

What documentation supports reporting this code?

The operative note should identify the flexor tendon and palm-level location, explain the indication for division, and document that an open tenotomy was performed.

What happens when another procedure is performed in the same session?

The highest-valued procedure is paid in full, and other procedures in the same session are subject to the standard multiple procedure reduction.

Can an assistant surgeon or co-surgeon be reported?

Assistant-at-surgery payment requires documentation of medical necessity. Co-surgeons and team surgery are not permitted for this code.

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 26450PPRRVU2026_Oct_nonQPP.csv, line 2,601 (RVU26D)

Open CMS sourceHow we calculate rates

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