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Billing code 26500: Pulley reconstructionMedicare rate & RVUs

Reconstructs a deficient tendon pulley in the hand without a tendon graft, typically to control bowstringing and restore tendon tracking.

CMS RVU26DEffective Oct 1, 2026109 payment localities93 Medicare services in 2024

Medicare pays $687.06 for 26500 nationally in a facility.

Medicare rate · 26500

Pulley reconstruction

Swap in your local Medicare rate.

Work RVUs
5.98
Total RVUs
20.57
Global days
090

National rate · 2026

$687.06

Facility setting, before claim adjustments.

See every locality for 26500 → · 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 26500 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 26500 covers

A hand surgeon reconstructs a damaged or deficient pulley that normally holds a flexor tendon close to the finger. The procedure may be considered when pulley failure causes the tendon to bow away from the phalanx and impairs tendon tracking. The reconstruction uses no tendon graft; the corresponding graft-based pulley reconstruction is a separate code. These cases are generally performed in an operating room, often by an orthopedic or plastic surgeon specializing in hand surgery.

Report the code for each tendon pulley reconstructed without a graft, and document the affected tendon, the pulley deficiency, the reconstructive work, and whether graft material was used. This major surgery has 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 the others at 50%. 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 26500 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

26500 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$612.93
Alaska*Unavailable$796.63
ArizonaUnavailable$667.12
ArkansasUnavailable$603.64
AtlantaUnavailable$703.36
AustinUnavailable$708.37
BakersfieldUnavailable$716.81
Baltimore/Surr. CntysUnavailable$732.84
BeaumontUnavailable$644.01
BrazoriaUnavailable$675.25

26500 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
26500 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 26500 rate is calculated

Each of 26500’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 · 26500

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 5.98Practice expense 13.31Malpractice 1.28

20.5700 adjusted RVUs×$33.4009 conversion factor=$687.06

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

Payment rules and modifiers for 26500

26500 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 26500

Pulley reconstruction

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)0Not paid without supporting documentation.
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 · 26500

Pulley reconstruction

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

26500 without 51 · national facility

$687.06

Pulley reconstruction

26500-51 · Second procedure: 50%

$343.53

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

26500 compared with similar codes

Compare codes

26500 vs 26502 vs 26510 vs 26440: national Medicare rates

Swap in your local Medicare rate.

  • 26500
    Pulley reconstruction · 5.98 wRVU
    —
  • 26502
    Pulley reconstruction · 7.13 wRVU
    —
  • 26510
    Tendon transfer · 5.46 wRVU
    —
  • 26440
    Flexor tenolysis · 5.03 wRVU
    —

How to choose

26502Pulley reconstruction
Both reconstruct a hand tendon pulley. Choose 26500 when no tendon graft is used and 26502 when the reconstruction uses a tendon graft.
26510Tendon transfer
A tendon transfer reroutes a tendon to change or restore its action. This code reconstructs the pulley that guides a tendon.
26440Flexor tenolysis
Tenolysis frees a tendon restricted by adhesions; it does not reconstruct a deficient pulley.

Codes related to 26500

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

Codes related to 26500
CodeHow it relatesNational office range
Same family
26502Pulley reconstructionPulley reconstruction in the hand using a tendon graft.No office rate
Often billed with
26440Flexor tenolysisTenolysis may accompany pulley reconstruction when separate tendon adhesions are also treated.No office rate
26510Tendon transferA tendon transfer may be performed for a separate functional problem in a complex hand reconstruction.No office rate

26500 billing questions

How is this code distinguished from 26502?

This code describes pulley reconstruction without a tendon graft. Use 26502 when the pulley reconstruction uses a tendon graft.

Is the code reported per hand or per reconstructed pulley?

The service is reported for each tendon pulley reconstructed. Document the tendon and pulley treated.

Can modifier 50 be used for reconstruction on both hands?

No. CMS identifies bilateral adjustment 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.

When is assistant-at-surgery payment allowed?

Only when the medical necessity of the assistant is documented. 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 26500PPRRVU2026_Oct_nonQPP.csv, line 2,621 (RVU26D)

Open CMS sourceHow we calculate rates

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