CPT code 26490: Thumb tendon repair, extensor tendon, no free graft2026 Medicare rate & RVUs in California
Reconstructs a thumb extensor tendon without a free graft, typically when a damaged or deficient tendon requires operative restoration.
CMS doesn’t publish an office rate for 26490 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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On this page 9 sections
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 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 | $849.81 |
| Chico, CA | Unavailable | $844.93 |
| El Centro, CA | Unavailable | $845.23 |
| Fresno, CA | Unavailable | $844.93 |
| Hanford, CA | Unavailable | $844.93 |
| Los Angeles, CA | Unavailable | $901.15 |
| Madera, CA | Unavailable | $844.93 |
| Marin County, CA | Unavailable | $1,013.58 |
| Merced, CA | Unavailable | $844.93 |
| Modesto, CA | Unavailable | $844.93 |
| Napa, CA | Unavailable | $963.16 |
| Oxnard, CA | Unavailable | $894.61 |
| Redding, CA | Unavailable | $844.93 |
| Rest of California | Unavailable | $844.93 |
| Riverside, CA | Unavailable | $863.95 |
| Sacramento, CA | Unavailable | $882.55 |
| Salinas, CA | Unavailable | $879.22 |
| San Benito County, CA | Unavailable | $1,037.76 |
| San Diego, CA | Unavailable | $897.13 |
| San Francisco, CA | Unavailable | $1,011.57 |
| San Luis Obispo, CA | Unavailable | $865.66 |
| Santa Clara County, CA | Unavailable | $1,029.54 |
| Santa Cruz, CA | Unavailable | $903.41 |
| Santa Maria, CA | Unavailable | $881.75 |
| Santa Rosa, CA | Unavailable | $912.19 |
| Stockton, CA | Unavailable | $844.93 |
| Vallejo, CA | Unavailable | $960.27 |
| Visalia, CA | Unavailable | $844.93 |
| Yuba City, CA | Unavailable | $844.93 |
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.
How the rate is built · 26490
RVUs × geographic indexes × conversion factor
Work8.39
8.39 RVUs× 1.000 GPCI
Practice expense14.43
14.43 RVUs× 1.000 GPCI
Malpractice1.77
1.77 RVUs× 1.000 GPCI
Adjusted RVUs
24.5900
Conversion factor
$33.4009
Medicare rate
$821.33
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 26490
26490 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 26490
Thumb tendon repair, extensor tendon, no 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 · 26490
Thumb tendon repair, extensor tendon, no 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
26490 without 51 · national facility
$821.33
Thumb tendon repair, extensor tendon, no free graft
26490-51 · Second procedure: 50%
$410.67
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%).
26490 compared with similar codes
Compare codes · National
5 codes, side by side
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.
26490 billing questions
How does this code differ from 26492?
This code describes thumb extensor tendon reconstruction without a free graft. Code 26492 is the related option when a free graft is used.
How does this differ from 26494?
Code 26494 is for reconstruction of a thumb flexor tendon without a free graft. Select based on whether the reconstructed tendon is an extensor or flexor tendon.
What documentation supports reporting this code?
Document the thumb extensor tendon involved, the tendon defect or dysfunction, the reconstructive work performed, and whether free graft tissue was used.
Can modifier 50 be used for both thumbs?
No. CMS identifies bilateral adjustment as inappropriate for this code; modifier 50 should not be used.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
When is assistant-at-surgery payment allowed?
CMS allows assistant-at-surgery payment only when medical necessity is documented. Co-surgeons and team surgery are not permitted.
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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