CPT code 26490: Thumb tendon repair, extensor tendon, no free graft2026 Medicare rate & RVUs

Medicare pays $821.33 for 26490 nationally in a facility.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 26490 covers

This code describes reconstruction of an extensor tendon in the thumb without using a free tendon graft. A hand surgeon may perform the procedure when an injury or chronic tendon problem leaves the extensor mechanism unable to extend the thumb normally and reconstruction is feasible without graft tissue. It is generally performed in an operating room, often in a hospital outpatient or ambulatory surgery setting.

Report the code when the operative work reconstructs the thumb extensor tendon and does not use a free graft; a graft-based reconstruction is represented by a different code. The operative report should identify the affected tendon, the defect or dysfunction, the reconstructive method, and whether graft tissue was used. CMS 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 other procedures are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate for this code. Assistant-at-surgery payment requires documented medical necessity; co-surgeon and team-surgery billing 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 26490 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

26490 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 26490 rate is calculated

Each of 26490’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.

Payment rules and modifiers for 26490

26490 has a 90-day global period: related visits in that window are included in the surgery payment.

What modifiers do to the payment

When to use modifier 51

26490 compared with similar codes

How to choose

26492Tendon transferThumb with free tendon graft

Both concern thumb extensor tendon reconstruction; 26492 applies when the reconstruction uses a free graft.

26494Tendon transferHand tendon or muscle

26494 addresses reconstruction of a thumb flexor tendon without a free graft, rather than an extensor tendon.

26496Thumb tendon transferMultiple tendons, free graft

26496 is for thumb flexor tendon reconstruction with a free graft; this code is for extensor tendon reconstruction without one.

26480Tendon transferDorsal hand, no free graft

26480 describes tendon transfer or transplant in the hand dorsum or carpometacarpal area, rather than reconstruction of a thumb extensor tendon without a free graft.

Codes related to 26490

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

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

Open CMS sourceHow we calculate rates