CPT code 26492: Tendon transfer, thumb with free tendon graft2026 Medicare rate & RVUs in Missouri
Reports thumb tendon reconstruction that uses a free tendon graft to reroute tendon function when the native tendon cannot restore useful motion.
CMS doesn’t publish an office rate for 26492 in Missouri.
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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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 in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | Unavailable | $869.58 |
| Metropolitan St. Louis, MO | Unavailable | $877.97 |
| Rest of Missouri | Unavailable | $829.82 |
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.
How the rate is built · 26492
RVUs × geographic indexes × conversion factor
Work9.59
9.59 RVUs× 1.000 GPCI
Practice expense15.38
15.38 RVUs× 1.000 GPCI
Malpractice2.05
2.05 RVUs× 1.000 GPCI
Adjusted RVUs
27.0200
Conversion factor
$33.4009
Medicare rate
$902.49
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 26492
26492 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 26492
Tendon transfer, thumb with free tendon 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) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| 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 · 26492
Tendon transfer, thumb with free tendon 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
26492 without 51 · national facility
$902.49
Tendon transfer, thumb with free tendon graft
26492-51 · Second procedure: 50%
$451.25
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%).
26492 compared with similar codes
Compare codes · National
5 codes, side by side
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.
26492 billing questions
How does this differ from 26490?
This code is for a thumb tendon reconstruction that uses a free tendon graft. Code 26490 is the related thumb procedure without a free tendon graft.
How is it distinguished from graft procedures for other hand sites?
Choose this code when the reconstructed tendon is in the thumb. Codes 26483 and 26489 describe graft procedures at the dorsum or palm, while 26498 is for a finger.
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 in the global period?
The 90-day major-surgery global period includes the day-before preoperative visit and 90 days of related postoperative care.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction when performed in the same session.
May an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team surgery is 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
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