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Billing code 26440: Flexor tenolysisMedicare rate & RVUs

Surgical release of adhesions limiting flexor tendon glide in the palm or finger, reported for each tendon treated.

CMS RVU26DEffective Oct 1, 2026109 payment localities5.1K Medicare services in 2024

Medicare pays $642.63 for 26440 nationally in a facility.

Medicare rate · 26440

Flexor tenolysis

Swap in your local Medicare rate.

Work RVUs
5.03
Total RVUs
19.24
Global days
090

National rate · 2026

$642.63

Facility setting, before claim adjustments.

See every locality for 26440 → · Billed by an NP, PA or therapist? →

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

On this page 10 sections
  1. Medicare rate
  2. What 26440 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 26440 covers

This operation frees a flexor tendon from scar tissue that restricts its movement through the palm or finger. A hand surgeon typically performs it when adhesions remain after a tendon injury or repair and limit active motion. The surgeon exposes the involved tendon and releases the surrounding scar while preserving the tendon and nearby structures. The service may be performed in a hospital or ambulatory surgery setting.

Report the code for each flexor tendon released in the palm and finger, and document the tendon, site, adhesions, and release performed. Use the more extensive-dissection sibling when the operative work meets that distinction. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures occur in one session, the highest-valued procedure is paid in full and others are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery; 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 26440 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

26440 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$573.40
Alaska*Unavailable$741.01
ArizonaUnavailable$624.30
ArkansasUnavailable$564.68
AtlantaUnavailable$656.66
AustinUnavailable$664.98
BakersfieldUnavailable$675.77
Baltimore/Surr. CntysUnavailable$685.23
BeaumontUnavailable$600.53
BrazoriaUnavailable$632.94

26440 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
26440 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 26440 rate is calculated

Each of 26440’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 · 26440

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 5.03Practice expense 13.25Malpractice 0.96

19.2400 adjusted RVUs×$33.4009 conversion factor=$642.63

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 26440

26440 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 26440

Flexor tenolysis

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.69/0.21Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 26440

Flexor tenolysis

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.

  • 24 Unrelated E/M visit by the same physician
  • 79 Unrelated procedure (starts its own global period)
  • 58 Staged, more extensive, or therapy procedure that was planned
  • 78 Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

26440 without 51 · national facility

$642.63

Flexor tenolysis

26440-51 · Second procedure: 50%

$321.32

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%).

When to use modifier 51

26440 compared with similar codes

Compare codes

26440 vs 26442 vs 26445 vs 26449 vs 26410: national Medicare rates

Swap in your local Medicare rate.

  • 26440
    Flexor tenolysis · 5.03 wRVU
    —
  • 26442
    Flexor tenolysis · 9.51 wRVU
    —
  • 26445
    Tendon release · 4.34 wRVU
    —
  • 26449
    Tendon release · 8.38 wRVU
    —
  • 26410
    Hand tendon repair · 4.65 wRVU
    —

How to choose

26442Flexor tenolysis
This code covers flexor tenolysis in the palm and finger without the extensive-dissection distinction. Choose 26442 when the operative work meets that sibling code's extensive-dissection criterion.
26445Tendon release
This code is for extensor tendon tenolysis in the hand or finger. Code 26440 concerns flexor tendon adhesions in the palm and finger.
26449Tendon release
This code addresses flexor tendon tenolysis at the forearm or wrist. Choose 26440 for the palm and finger site.
26410Hand tendon repair
This code repairs a hand tendon; 26440 releases adhesions restricting a tendon that is already present. The operative purpose, not simply a history of tendon injury, distinguishes them.

Codes related to 26440

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 26440
CodeHow it relatesNational office range
Same family
26442Flexor tenolysisFlexor tendon adhesion release in the palm and finger when extensive dissection is required.No office rate
26445Tendon releaseTenolysis for an extensor tendon in the hand or finger rather than a flexor tendon.No office rate
26449Tendon releaseFlexor tendon tenolysis involving the forearm or wrist site.No office rate

26440 billing questions

How is this code distinguished from 26442?

Both describe flexor tendon adhesion release in the palm and finger. Use 26442 when the operative work requires the extensive dissection specified for that sibling code.

Is the code reported once per hand or once per tendon?

It is reported for each tendon released. The operative note should identify each treated tendon and its location.

Can modifier 50 be used when both hands are treated?

No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this code.

Are related postoperative visits included?

Yes. The 90-day global period includes related postoperative care and the day-before preoperative visit.

Can an assistant surgeon or co-surgeon be billed?

Medicare does not pay an assistant at surgery for this service. Co-surgeons and team surgery are not permitted.

What happens when this is performed with another procedure in the same session?

The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction.

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
RVUs for 26440PPRRVU2026_Oct_nonQPP.csv, line 2,597 (RVU26D)

Open CMS sourceHow we calculate rates

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