CPT code 26542: Joint ligament repair, with tendon graft2026 Medicare rate & RVUs in California
Reports repair of a hand joint collateral ligament using a tendon graft when the surgeon restores stability at a metacarpophalangeal or interphalangeal joint.
CMS doesn’t publish an office rate for 26542 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 26542 covers
The surgeon repairs a deficient collateral ligament at a metacarpophalangeal or interphalangeal joint using a tendon graft. This may be needed for chronic instability or a ligament injury that cannot be adequately repaired with the patient’s existing tissue. Hand surgeons typically perform the operation in a hospital outpatient department or ambulatory surgery center; a tendon graft may be harvested as part of the procedure.
Report the code when the operative work includes ligament repair with a tendon graft, rather than direct repair or augmentation using local tissue. The operative report should identify the joint, ligament, instability or injury, graft, and repair technique. 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 50% reduction. Modifier 50 is inappropriate for this code. Assistant-at-surgery payment requires documented 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 26542 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 | $725.05 |
| Chico, CA | Unavailable | $721.42 |
| El Centro, CA | Unavailable | $721.64 |
| Fresno, CA | Unavailable | $721.42 |
| Hanford, CA | Unavailable | $721.42 |
| Los Angeles, CA | Unavailable | $769.55 |
| Madera, CA | Unavailable | $721.42 |
| Marin County, CA | Unavailable | $869.78 |
| Merced, CA | Unavailable | $721.42 |
| Modesto, CA | Unavailable | $721.42 |
| Napa, CA | Unavailable | $825.39 |
| Oxnard, CA | Unavailable | $764.40 |
| Redding, CA | Unavailable | $721.42 |
| Rest of California | Unavailable | $721.42 |
| Riverside, CA | Unavailable | $735.42 |
| Sacramento, CA | Unavailable | $754.33 |
| Salinas, CA | Unavailable | $751.49 |
| San Benito County, CA | Unavailable | $890.18 |
| San Diego, CA | Unavailable | $767.31 |
| San Francisco, CA | Unavailable | $868.30 |
| San Luis Obispo, CA | Unavailable | $739.78 |
| Santa Clara County, CA | Unavailable | $884.14 |
| Santa Cruz, CA | Unavailable | $773.13 |
| Santa Maria, CA | Unavailable | $753.80 |
| Santa Rosa, CA | Unavailable | $780.71 |
| Stockton, CA | Unavailable | $721.42 |
| Vallejo, CA | Unavailable | $823.26 |
| Visalia, CA | Unavailable | $721.42 |
| Yuba City, CA | Unavailable | $721.42 |
How the 26542 rate is calculated
Each of 26542’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 · 26542
RVUs × geographic indexes × conversion factor
Work6.78
6.78 RVUs× 1.000 GPCI
Practice expense12.78
12.78 RVUs× 1.000 GPCI
Malpractice1.30
1.30 RVUs× 1.000 GPCI
Adjusted RVUs
20.8600
Conversion factor
$33.4009
Medicare rate
$696.74
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 26542
26542 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 26542
Joint ligament repair, with 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) | 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 · 26542
Joint ligament repair, with 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
26542 without 51 · national facility
$696.74
Joint ligament repair, with tendon graft
26542-51 · Second procedure: 50%
$348.37
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%).
26542 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 26540Ligament repairMCP or IP joint
- Choose 26540 for collateral ligament repair without a tendon graft; 26542 captures repair using a tendon graft.
- 26541Ligament repairWith tendon graft
- Choose 26541 when local tissue is used for the ligament repair. A tendon graft points to 26542.
- 26545Finger joint reconstructionLigament reconstruction with graft
- 26545 describes collateral ligament reconstruction at the metacarpophalangeal joint with a tendon graft. Distinguish it from 26542 by the procedure performed and the joint involved.
26542 billing questions
How does this differ from 26540?
Use 26542 when the collateral ligament repair uses a tendon graft. Code 26540 describes collateral ligament repair without that graft technique.
How does this differ from 26541?
Code 26541 is for collateral ligament repair using local tissue. Code 26542 identifies repair with a tendon graft.
What should the operative note document?
Document the affected metacarpophalangeal or interphalangeal joint, the collateral ligament and its deficiency, and the tendon graft repair performed.
Can modifier 50 be used for both hands?
No. CMS identifies bilateral adjustment as inappropriate for this code. The descriptor or anatomy makes modifier 50 unsuitable.
How are other procedures in the same session paid?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and the others are paid at 50%. Assistant-at-surgery payment requires documented medical necessity.
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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