CPT code 26496: Thumb tendon transfer, multiple tendons, free graft2026 Medicare rate & RVUs in California
Reports operative transfer or transplantation of multiple thumb tendons using a free graft to restore thumb motion or function.
CMS doesn’t publish an office rate for 26496 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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What 26496 covers
This code represents operative transfer or transplantation involving multiple thumb tendons with a free graft. The surgeon redirects tendon function and uses a graft to bridge or augment the reconstruction. It may be performed by a hand or orthopedic surgeon for traumatic tendon loss or chronic dysfunction that impairs thumb movement. The operative report should establish the thumb tendons involved and describe the graft and reconstruction performed.
Select this code when the documented procedure involves multiple thumb tendons and a free graft; a single tendon or a reconstruction without a free graft points to a different code in the family. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. When other 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 documentation of 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.
Where 26496 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 | $907.62 |
| Chico, CA | Unavailable | $902.01 |
| El Centro, CA | Unavailable | $902.35 |
| Fresno, CA | Unavailable | $902.01 |
| Hanford, CA | Unavailable | $902.01 |
| Los Angeles, CA | Unavailable | $961.35 |
| Madera, CA | Unavailable | $902.01 |
| Marin County, CA | Unavailable | $1,076.73 |
| Merced, CA | Unavailable | $902.01 |
| Modesto, CA | Unavailable | $902.01 |
| Napa, CA | Unavailable | $1,024.42 |
| Oxnard, CA | Unavailable | $953.92 |
| Redding, CA | Unavailable | $902.01 |
| Rest of California | Unavailable | $902.01 |
| Riverside, CA | Unavailable | $923.93 |
| Sacramento, CA | Unavailable | $941.16 |
| Salinas, CA | Unavailable | $937.59 |
| San Benito County, CA | Unavailable | $1,102.56 |
| San Diego, CA | Unavailable | $955.96 |
| San Francisco, CA | Unavailable | $1,074.41 |
| San Luis Obispo, CA | Unavailable | $923.25 |
| Santa Clara County, CA | Unavailable | $1,093.09 |
| Santa Cruz, CA | Unavailable | $962.07 |
| Santa Maria, CA | Unavailable | $940.09 |
| Santa Rosa, CA | Unavailable | $971.36 |
| Stockton, CA | Unavailable | $902.01 |
| Vallejo, CA | Unavailable | $1,021.09 |
| Visalia, CA | Unavailable | $902.01 |
| Yuba City, CA | Unavailable | $902.01 |
How the 26496 rate is calculated
Each of 26496’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 · 26496
RVUs × geographic indexes × conversion factor
Work9.54
9.54 RVUs× 1.000 GPCI
Practice expense14.79
14.79 RVUs× 1.000 GPCI
Malpractice2.04
2.04 RVUs× 1.000 GPCI
Adjusted RVUs
26.3700
Conversion factor
$33.4009
Medicare rate
$880.78
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 26496
26496 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 26496
Thumb tendon transfer, multiple tendons, 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 · 26496
Thumb tendon transfer, multiple tendons, 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
26496 without 51 · national facility
$880.78
Thumb tendon transfer, multiple tendons, free graft
26496-51 · Second procedure: 50%
$440.39
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%).
26496 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 26494Tendon transferHand tendon or muscle
- Use 26494 for the multiple-tendon thumb reconstruction when no free graft is used. The free graft is the key distinction for 26496.
- 26492Tendon transferThumb with free tendon graft
- This is the single-tendon thumb reconstruction with a free graft; 26496 is for multiple thumb tendons with a free graft.
- 26480Tendon transferDorsal hand, no free graft
- This code addresses tendon transfer or transplantation in the carpometacarpal area or dorsum of the hand. Choose 26496 for the multiple-tendon thumb procedure with a free graft.
- 26497Tendon transferFinger flexor tendon
- This code concerns finger tendon transfer. Code 26496 is the thumb-specific multiple-tendon reconstruction with a free graft.
26496 billing questions
How does this code differ from 26494?
Both concern multiple thumb tendons, but 26496 is selected when the reconstruction uses a free graft. Code 26494 describes the multiple-tendon alternative without a free graft.
What documentation supports reporting this code?
The operative report should identify the thumb tendons treated, describe the transfer or transplant, and document use of a free graft. It should make clear that multiple tendons were involved.
Can modifier 50 be reported?
No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this code.
How does the 90-day global period affect postoperative reporting?
The day-before preoperative visit and 90 days of related postoperative care are included in the global period.
Can an assistant or another surgeon be reported?
Assistant-at-surgery payment requires documentation of medical necessity. Co-surgeons and team surgery are not permitted.
What happens when another procedure is performed in the same session?
Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%.
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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