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CPT code 26489: Tendon transfer, palm, with free graft2026 Medicare rate & RVUs

Reports graft-assisted rerouting of a tendon in the palm to restore hand motion or improve tendon balance when reconstruction requires a free graft.

CMS RVU26DEffective Oct 1, 2026109 payment localities45 Medicare services in 2024

Medicare pays $940.57 for 26489 nationally in a facility.

Medicare rate · 26489

Tendon transfer, palm, with free graft

Office or facility?

Work RVUs
9.61
Total RVUs
28.16
Global days
090

National rate · 2026

$940.57

Facility setting, before claim adjustments.

See every locality for 26489 →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 26489 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 26489 covers

A hand surgeon uses a free tendon graft to reroute or reconstruct a tendon in the palm when the existing tendon cannot provide the needed motion or balance. The service may be part of reconstructive surgery for tendon loss, rupture, or functional imbalance. The operative report should identify the tendon and palm site, explain the transfer or reconstruction, and document use of a free graft.

Select this code for the palm procedure that uses a free graft, rather than the palm procedure without one or a graft procedure at another hand site. The graft procurement is included in this service. Medicare assigns a 90-day global period, which includes the day-before preoperative visit and related postoperative care during that period. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate for this palm-specific service. 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 26489 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

26489 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$841.96
AlaskaUnavailable$1,106.14
ArizonaUnavailable$913.62
ArkansasUnavailable$829.65
Atlanta, GAUnavailable$964.11
Austin, TXUnavailable$965.37
Bakersfield, CAUnavailable$972.80
Baltimore area, MDUnavailable$1,002.16
Beaumont, TXUnavailable$886.11
Brazoria, TXUnavailable$923.11

26489 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
26489 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 26489 rate is calculated

Each of 26489’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 · 26489

RVUs × geographic indexes × conversion factor

Office or facility?

Work9.61

9.61 RVUs× 1.000 GPCI

Practice expense16.50

16.50 RVUs× 1.000 GPCI

Malpractice2.05

2.05 RVUs× 1.000 GPCI

Adjusted RVUs

28.1600

Conversion factor

$33.4009

Medicare rate

$940.57

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

Payment rules and modifiers for 26489

26489 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 26489

Tendon transfer, palm, with free 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)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 · 26489

Tendon transfer, palm, 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.

  • 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

26489 without 51 · national facility

$940.57

Tendon transfer, palm, with free graft

26489-51 · Second procedure: 50%

$470.29

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

26489 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 26489

    Tendon transfer, palm, with free graft9.61 wRVU

    Not priced

  • 26485

    Tendon transfer, palm, without free graft7.69 wRVU

    Not priced

  • 26483

    Tendon transfer, dorsal hand/CMC, with graft8.27 wRVU

    Not priced

  • 26440

    Flexor tenolysis, palm and finger5.03 wRVU

    Not priced

How to choose

26485Tendon transferPalm, without free graft
Both concern tendon work in the palm; the deciding feature is whether a free graft is used. This code is for the grafted procedure, while 26485 is for the procedure without one.
26483Tendon transferDorsal hand/CMC, with graft
This code identifies the palm site. Code 26483 is the related grafted tendon procedure for the hand site; use the code that matches the documented operative location.
26440Flexor tenolysisPalm and finger
Code 26440 describes release of a palm or finger tendon, not graft-assisted tendon rerouting or reconstruction.

Codes related to 26489

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

Codes related to 26489
CodeHow it relatesNational office range
Same family
26485Tendon transfer, palm, without free graftPalm tendon procedure without the free graft included in this code.No office rate
26483Tendon transfer, dorsal hand/CMC, with graftGraft-assisted tendon procedure at the hand site rather than the palm-specific site.No office rate
26480Tendon transfer, dorsal hand, no free graftHand tendon transfer or transplant code without a free graft.No office rate
Used instead
26492Tendon transfer, thumb with free tendon graftA separate grafted tendon-transfer option; select it when its specified procedure fits the operative work.No office rate

26489 billing questions

How is this code distinguished from 26485?

Both describe a tendon procedure in the palm, but this code involves a free graft. Use 26485 when the palm procedure is performed without a free graft.

Can the tendon graft harvest be billed separately?

Graft procurement is included in this service. The operative note should document the graft and its role in the palm tendon reconstruction.

What documentation supports reporting this code?

Document the tendon and palm site, the rerouting or reconstruction performed, and the use of a free tendon graft. The record should make clear why the graft was needed.

How many units should be reported?

The service is reported per tendon. Identify each treated tendon in the operative documentation and follow applicable claim instructions for units.

Can modifier 50 be used when both hands are treated?

Modifier 50 is inappropriate for this palm-specific service. The CMS rule for this code does not provide a bilateral adjustment.

What payment rules affect the surgical claim?

The code has a 90-day global period. In a same-session multiple-procedure claim, the highest-valued procedure is paid in full and other procedures are subject to the standard reduction; assistant payment requires medical-necessity documentation.

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 26489PPRRVU2026_Oct_nonQPP.csv, line 2,613 (RVU26D)

Open CMS sourceHow we calculate rates

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