CPT code 26450: Tendon tenotomy, flexor tendon in palm2026 Medicare rate & RVUs in California
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 doesn’t publish an office rate for 26450 in California.
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 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 in California
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield, CA | Unavailable | $482.25 |
| Chico, CA | Unavailable | $480.32 |
| El Centro, CA | Unavailable | $480.43 |
| Fresno, CA | Unavailable | $480.32 |
| Hanford, CA | Unavailable | $480.32 |
| Los Angeles, CA | Unavailable | $513.40 |
| Madera, CA | Unavailable | $480.32 |
| Marin County, CA | Unavailable | $586.24 |
| Merced, CA | Unavailable | $480.32 |
| Modesto, CA | Unavailable | $480.32 |
| Napa, CA | Unavailable | $554.69 |
| Oxnard, CA | Unavailable | $510.54 |
| Redding, CA | Unavailable | $480.32 |
| Rest of California | Unavailable | $480.32 |
| Riverside, CA | Unavailable | $487.75 |
| Sacramento, CA | Unavailable | $503.59 |
| Salinas, CA | Unavailable | $501.72 |
| San Benito County, CA | Unavailable | $599.86 |
| San Diego, CA | Unavailable | $513.29 |
| San Francisco, CA | Unavailable | $585.46 |
| San Luis Obispo, CA | Unavailable | $493.75 |
| Santa Clara County, CA | Unavailable | $596.66 |
| Santa Cruz, CA | Unavailable | $517.97 |
| Santa Maria, CA | Unavailable | $503.54 |
| Santa Rosa, CA | Unavailable | $523.15 |
| Stockton, CA | Unavailable | $480.32 |
| Vallejo, CA | Unavailable | $553.56 |
| Visalia, CA | Unavailable | $480.32 |
| Yuba City, CA | Unavailable | $480.32 |
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
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
| 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) | 0 | Not paid without supporting documentation. |
| 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 · 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.
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%).
26450 compared with similar codes
Compare codes · National
4 codes, side by side
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.
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
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