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CPT code 26442: Flexor tenolysis2026 Medicare rate & RVUs

Reports secondary release of adhesions limiting flexor tendon glide in the palm or finger when the procedure includes a free tendon graft.

CMS RVU26DEffective Oct 1, 2026109 payment localities2.4K Medicare services in 2024

Medicare pays $960.94 for 26442 nationally in a facility.

Medicare rate · 26442

Flexor tenolysis

Office or facility?

Work RVUs
9.51
Total RVUs
28.77
Global days
090

National rate · 2026

$960.94

Facility setting, before claim adjustments.

See every locality for 26442 →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.

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What 26442 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 26442 covers

This procedure addresses a flexor tendon in the palm or finger that remains tethered by scar tissue and cannot glide adequately, often after an earlier tendon injury or repair. The surgeon frees the tendon and uses a free tendon graft as part of the secondary reconstruction. Hand surgeons typically perform it in an operating room, with the operative report identifying the involved tendon, adhesion release, and graft work.

Report 26442 for the secondary flexor tenolysis with free graft; 26440 is the related choice for flexor tenolysis without that graft work. The record should support the affected tendon, the adhesions restricting excursion, and the graft used. 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 others at 50%. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this service, and 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 26442 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

26442 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$861.54
AlaskaUnavailable$1,129.99
ArizonaUnavailable$934.06
ArkansasUnavailable$849.10
Atlanta, GAUnavailable$983.56
Austin, TXUnavailable$988.32
Bakersfield, CAUnavailable$998.81
Baltimore area, MDUnavailable$1,023.07
Beaumont, TXUnavailable$904.21
Brazoria, TXUnavailable$944.73

26442 rates by state

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

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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
26442 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 26442 rate is calculated

Each of 26442’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 · 26442

RVUs × geographic indexes × conversion factor

Office or facility?

Work9.51

9.51 RVUs× 1.000 GPCI

Practice expense17.42

17.42 RVUs× 1.000 GPCI

Malpractice1.84

1.84 RVUs× 1.000 GPCI

Adjusted RVUs

28.7700

Conversion factor

$33.4009

Medicare rate

$960.94

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 26442

26442 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 26442

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 · 26442

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.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned 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

26442 without 51 · national facility

$960.94

Flexor tenolysis

26442-51 · Second procedure: 50%

$480.47

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

26442 compared with similar codes

Compare codes · National

5 codes, side by side

Office or facility?

  • 26442

    Flexor tenolysis9.51 wRVU

    Not priced

  • 26440

    Flexor tenolysis5.03 wRVU

    Not priced

  • 26445

    Tendon release4.34 wRVU

    Not priced

  • 26449

    Tendon release8.38 wRVU

    Not priced

  • 26416

    Tendon graft9.32 wRVU

    Not priced

How to choose

26440Flexor tenolysis
Both address flexor tendon adhesions in the palm and finger. Choose 26442 when secondary tenolysis includes a free tendon graft; 26440 is the choice without that graft work.
26445Tendon release
This code is for extensor tendon tenolysis in the hand or finger. Code 26442 concerns flexor tendon tenolysis with a free graft.
26449Tendon release
This code addresses extensor tendon tenolysis involving the forearm or hand, rather than the palm-and-finger flexor tendon procedure reported with 26442.
26416Tendon graft
Use 26416 for hand or finger tendon grafting when graft reconstruction is the service performed; 26442 describes secondary flexor tenolysis with a free graft.

Codes related to 26442

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

Codes related to 26442
CodeHow it relatesNational office range
Same family
26440Flexor tenolysisFlexor tendon tenolysis in the palm and finger without the secondary free-graft work.No office rate
26445Tendon releaseTenolysis for an extensor tendon in the hand or finger rather than a flexor tendon.No office rate
26449Tendon releaseExtensor tendon tenolysis involving the forearm or hand.No office rate
Used instead
26416Tendon graftTendon grafting when reconstruction, rather than secondary flexor tenolysis, is the procedure performed.No office rate

26442 billing questions

How does 26442 differ from 26440?

Both concern flexor tendon tenolysis in the palm and finger. Use 26442 for the secondary procedure with a free tendon graft; use 26440 for tenolysis without that graft work.

Is the free tendon graft separately reported?

The graft is part of the service described by 26442. Document the graft and its role in the secondary tendon procedure.

Can modifier 50 be used for procedures on both hands?

No. CMS identifies modifier 50 as inappropriate for this code.

What postoperative care is included?

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

How are other procedures in the same session paid?

Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%.

Is an assistant surgeon or co-surgeon payable?

Medicare does not pay an assistant at surgery for 26442. Co-surgeons and team surgery are 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

Show the CMS file lines behind this rate
RVUs for 26442PPRRVU2026_Oct_nonQPP.csv, line 2,598 (RVU26D)

Open CMS sourceHow we calculate rates

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