CPT code 26492: Tendon transfer, thumb with free tendon graft2026 Medicare rate & RVUs

Medicare pays $902.49 for 26492 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 26492 covers

An orthopedic or hand surgeon uses a free tendon graft to reconstruct a thumb tendon pathway, redirecting tendon force to restore useful thumb motion when the native tendon is deficient. The procedure is typically performed in an operating room for reconstructive problems such as tendon loss or rupture. The operative work includes placing and attaching the graft as part of the thumb tendon reconstruction. This code distinguishes a graft-based thumb procedure from tendon transfer without a graft and from graft procedures at other hand sites.

The operative report should identify the thumb tendon or functional deficit, use of a free graft, and the transfer route and attachments. CMS assigns a 90-day major-surgery global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in the same session, the highest-valued procedure is paid in full and the others are subject to the standard 50% reduction. Modifier 50 is inappropriate. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is 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 26492 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

26492 rates by state

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

How the 26492 rate is calculated

Each of 26492’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 26492

26492 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

26492 compared with similar codes

How to choose

26490Thumb tendon repairExtensor tendon, no free graft

Both concern thumb tendon transfer. Use 26492 when the reconstruction uses a free tendon graft; use 26490 when it does not.

26483Tendon transferDorsal hand/CMC, with graft

This code is specific to the thumb. Code 26483 describes the graft-based tendon procedure at the carpometacarpal area or dorsum of the hand.

26489Tendon transferPalm, with free graft

This code is for the thumb, while 26489 describes a graft-based tendon procedure at the palm.

26498Tendon transferFinger flexor tendon

Both involve a free tendon graft, but 26492 is for the thumb and 26498 is for a finger.

Codes related to 26492

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