CPT code 26489: Tendon transfer, palm, with free graft2026 Medicare rate & RVUs in Vermont
Reports graft-assisted rerouting of a tendon in the palm to restore hand motion or improve tendon balance when reconstruction requires a free graft.
In Vermont, Medicare pays $901.23 for 26489 in a facility. There’s no office rate.
Check a contract rate as a % of Medicare · 26489 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
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.
How Vermont compares for 26489
Across 109 of 109 payment localities, the facility rate for 26489 runs from $829.65 in Arkansas to $1,187.70 in San Benito County, CA. Vermont pays $901.23. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Vermont · this page$901.23
- Los Angeles, CA · California$1,031.58+$130.35
- Washington, DC area · District of Columbia$1,063.74+$162.51
- Miami, FL · Florida$1,067.86+$166.63
- Chicago, IL · Illinois$1,034.24+$133.01
- Manhattan, NY · New York$1,090.52+$189.29
- Alaska · Alaska$1,106.14+$204.91
Other areas in Vermont first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | — | $841.96 |
| ArkansasArkansas | — | $829.65 |
| ArizonaArizona | — | $913.62 |
| Bakersfield, CACalifornia | — | $972.80 |
| Chico, CACalifornia | — | $967.16 |
| El Centro, CACalifornia | — | $967.50 |
| Fresno, CACalifornia | — | $967.16 |
| Hanford, CACalifornia | — | $967.16 |
| Madera, CACalifornia | — | $967.16 |
| Merced, CACalifornia | — | $967.16 |
| Modesto, CACalifornia | — | $967.16 |
| Napa, CACalifornia | — | $1,102.36 |
| Oxnard, CACalifornia | — | $1,024.05 |
| Redding, CACalifornia | — | $967.16 |
| Rest of CaliforniaCalifornia | — | $967.16 |
| Riverside, CACalifornia | — | $989.19 |
| Sacramento, CACalifornia | — | $1,010.19 |
| Salinas, CACalifornia | — | $1,006.38 |
| San Diego, CACalifornia | — | $1,026.86 |
| Marin County, CACalifornia | — | $1,159.98 |
| San Francisco, CACalifornia | — | $1,157.65 |
| San Benito County, CACalifornia | — | $1,187.70 |
| Santa Clara County, CACalifornia | — | $1,178.18 |
| San Luis Obispo, CACalifornia | — | $990.86 |
| Santa Cruz, CACalifornia | — | $1,034.03 |
| Santa Maria, CACalifornia | — | $1,009.27 |
| Santa Rosa, CACalifornia | — | $1,044.08 |
| Stockton, CACalifornia | — | $967.16 |
| Vallejo, CACalifornia | — | $1,099.00 |
| Visalia, CACalifornia | — | $967.16 |
| Yuba City, CACalifornia | — | $967.16 |
| ColoradoColorado | — | $964.70 |
| ConnecticutConnecticut | — | $1,003.80 |
| DelawareDelaware | — | $928.65 |
| Fort Lauderdale, FLFlorida | — | $1,003.06 |
| Rest of FloridaFlorida | — | $950.76 |
| Atlanta, GAGeorgia | — | $964.11 |
| Rest of GeorgiaGeorgia | — | $894.20 |
| Hawaii, Guam, HIHawaii | — | $987.25 |
| IowaIowa | — | $852.44 |
| IdahoIdaho | — | $860.40 |
| East St. Louis, ILIllinois | — | $965.91 |
| Rest of IllinoisIllinois | — | $931.17 |
| Suburban Chicago, ILIllinois | — | $1,010.56 |
| IndianaIndiana | — | $865.14 |
| KansasKansas | — | $853.70 |
| KentuckyKentucky | — | $873.58 |
| New Orleans, LALouisiana | — | $917.37 |
| Rest of LouisianaLouisiana | — | $874.32 |
| Metropolitan Boston, MAMassachusetts | — | $1,053.11 |
| Rest of MassachusettsMassachusetts | — | $961.01 |
| Baltimore area, MDMaryland | — | $1,002.16 |
| Rest of MarylandMaryland | — | $944.78 |
| Rest of MaineMaine | — | $870.60 |
| Southern Maine, MEMaine | — | $910.34 |
| Detroit, MIMichigan | — | $968.25 |
| Rest of MichiganMichigan | — | $901.46 |
| MinnesotaMinnesota | — | $908.35 |
| Metropolitan Kansas City, MOMissouri | — | $905.38 |
| Metropolitan St. Louis, MOMissouri | — | $914.25 |
| Rest of MissouriMissouri | — | $862.74 |
| MississippiMississippi | — | $846.09 |
| MontanaMontana | — | $940.43 |
| North CarolinaNorth Carolina | — | $878.93 |
| North DakotaNorth Dakota | — | $899.90 |
| NebraskaNebraska | — | $855.54 |
| New HampshireNew Hampshire | — | $954.61 |
| Northern New JerseyNew Jersey | — | $1,053.63 |
| Rest of New JerseyNew Jersey | — | $1,010.75 |
| New MexicoNew Mexico | — | $908.59 |
| NevadaNevada | — | $929.69 |
| NYC suburbs and Long Island, NYNew York | — | $1,123.95 |
| Poughkeepsie and northern NYC suburbs, NYNew York | — | $1,021.75 |
| Queens, NYNew York | — | $1,091.68 |
| Rest of New YorkNew York | — | $892.68 |
| OhioOhio | — | $893.17 |
| OklahomaOklahoma | — | $866.33 |
| Portland, OROregon | — | $989.35 |
| Rest of OregonOregon | — | $918.03 |
| Metropolitan Philadelphia, PAPennsylvania | — | $982.16 |
| Rest of PennsylvaniaPennsylvania | — | $891.61 |
| Puerto RicoPuerto Rico | — | $945.60 |
| Rhode IslandRhode Island | — | $957.46 |
| South CarolinaSouth Carolina | — | $888.41 |
| South DakotaSouth Dakota | — | $895.10 |
| TennesseeTennessee | — | $858.72 |
| Austin, TXTexas | — | $965.37 |
| Beaumont, TXTexas | — | $886.11 |
| Brazoria, TXTexas | — | $923.11 |
| Dallas, TXTexas | — | $931.53 |
| Fort Worth, TXTexas | — | $926.91 |
| Galveston, TXTexas | — | $927.50 |
| Houston, TXTexas | — | $965.02 |
| Rest of TexasTexas | — | $905.82 |
| UtahUtah | — | $900.52 |
| VirginiaVirginia | — | $911.07 |
| Virgin Islands, VIUnited States Virgin Islands | — | $945.60 |
| Rest of WashingtonWashington | — | $957.59 |
| King County, WAWashington | — | $1,069.19 |
| WisconsinWisconsin | — | $870.04 |
| West VirginiaWest Virginia | — | $897.88 |
| WyomingWyoming | — | $922.77 |
26489 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
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
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
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
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.
The exact Vermont inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
2,613
- Code
- 26489
- Physician work
- 9.61
- Practice expense
- 16.50
- Malpractice
- 2.05
GPCI2026.csv
105
- Locality
- Vermont
- Physician work
- 1.000
- Practice expense
- 0.990
- Malpractice
- 0.506
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 9.61 | × 1.000 | 9.6100 |
| Practice expense | 16.50 | × 0.990 | 16.3350 |
| Malpractice | 2.05 | × 0.506 | 1.0373 |
| Total RVUs | 26.9823 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Vermont$901.23
Facility: (9.61 × 1 + 16.5 × 0.99 + 2.05 × 0.506) × $33.4009 = $901.23
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
| 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 · 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.
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%).
How 26489 has changed in Vermont
26489 · Office / nonfacility
Rate unavailable
Effective 2026-10-01
A rate is unavailable in one of these releases, so a change cannot be calculated.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | Not available in this setting | $901.23 | RVU26D |
| 2026-07-01 | Not available in this setting | $901.23 | RVU26C |
| 2026-04-01 | Not available in this setting | $901.23 | RVU26B |
| 2026-01-01 | Not available in this setting | $901.23 | RVU26A |
| 2025-10-01 | Not available in this setting | $906.53 | RVU25D |
| 2025-07-01 | Not available in this setting | $906.53 | RVU25C |
| 2025-04-01 | Not available in this setting | $906.53 | RVU25B |
| 2025-01-01 | Not available in this setting | $906.53 | RVU25A |
| 2024-10-01 | Not available in this setting | $936.89 | RVU24D |
| 2024-07-01 | Not available in this setting | $936.89 | RVU24C |
| 2024-04-01 | Not available in this setting | $936.89 | RVU24B |
| 2024-03-09 | Not available in this setting | $936.89 | RVU24AR |
| 2024-01-01 | Not available in this setting | $921.59 | RVU24A |
| 2023-10-01 | Not available in this setting | $960.64 | RVU23D |
| 2023-07-01 | Not available in this setting | $960.64 | RVU23C |
| 2023-04-01 | Not available in this setting | $960.64 | RVU23B |
| 2023-01-01 | Not available in this setting | $960.64 | RVU23A |
| 2022-10-01 | Not available in this setting | $982.90 | RVU22D |
| 2022-07-01 | Not available in this setting | $982.90 | RVU22C |
| 2022-04-01 | Not available in this setting | $982.90 | RVU22B |
| 2022-01-01 | Not available in this setting | $982.90 | RVU22A |
| 2021-10-01 | Not available in this setting | $979.83 | RVU21D |
| 2021-07-01 | Not available in this setting | $979.83 | RVU21C |
| 2021-04-01 | Not available in this setting | $979.83 | RVU21B |
| 2021-01-01 | Not available in this setting | $979.83 | RVU21A |
| 2020-10-01 | Not available in this setting | $955.57 | RVU20D |
| 2020-07-01 | Not available in this setting | $955.57 | RVU20C |
| 2020-04-01 | Not available in this setting | $955.57 | RVU20B |
| 2020-01-01 | Not available in this setting | $955.57 | RVU20A |
| 2019-10-01 | Not available in this setting | $932.21 | RVU19D |
| 2019-07-01 | Not available in this setting | $932.21 | RVU19C |
| 2019-04-01 | Not available in this setting | $929.85 | RVU19B |
| 2019-01-01 | Not available in this setting | $929.85 | RVU19A |
| 2018-10-01 | Not available in this setting | $936.39 | RVU18D |
| 2018-07-01 | Not available in this setting | $936.39 | RVU18C |
| 2018-04-01 | Not available in this setting | $936.39 | RVU18B |
| 2018-01-01 | Not available in this setting | $936.39 | RVU18AR1 |
| 2017-10-01 | Not available in this setting | $925.89 | RVU17D |
| 2017-07-01 | Not available in this setting | $925.89 | RVU17C |
| 2017-04-01 | Not available in this setting | $925.89 | RVU17B |
| 2017-01-01 | Not available in this setting | $925.89 | RVU17A |
| 2016-10-01 | Not available in this setting | $903.49 | RVU16D |
| 2016-07-01 | Not available in this setting | $903.49 | RVU16C |
| 2016-04-01 | Not available in this setting | $903.49 | RVU16B |
| 2016-01-01 | Not available in this setting | $903.49 | RVU16A |
| 2015-10-01 | Not available in this setting | $932.60 | RVU15D |
| 2015-07-01 | Not available in this setting | $932.60 | RVU15C |
| 2015-04-01 | Not available in this setting | $927.96 | RVU15B |
| 2015-01-01 | Not available in this setting | $927.96 | RVU15A |
| 2014-10-01 | Not available in this setting | $909.87 | RVU14D |
| 2014-07-01 | Not available in this setting | $909.87 | RVU14C |
| 2014-04-01 | Not available in this setting | $909.87 | RVU14B |
| 2014-01-01 | Not available in this setting | $909.87 | RVU14A |
| 2013-10-01 | Not available in this setting | Rate data unavailable | RVU13D |
| 2013-07-01 | Not available in this setting | Rate data unavailable | RVU13C |
| 2013-04-01 | Not available in this setting | Rate data unavailable | RVU13B |
| 2013-01-01 | Not available in this setting | Rate data unavailable | RVU13AR |
Where the Vermont rate applies
Vermont is a Medicare payment area, not a city. Our Census mapping connects it to 180 cities and communities in Vermont. Some span more than one payment area; confirm with the service ZIP.
- Albany
- Alburgh
- Algiers
- Arlington
- Ascutney
- Bakersfield
- Barnet
- Barre
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
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