No office rate
Choose 26450 for open flexor tendon division in the palm and 26455 when the division is at the finger.
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CMS RVU26D · Effective 2026-10-01
26450 Tendon tenotomy Medicare reimbursement rates in Guam
Open division of a flexor tendon in the palm is reported when a hand surgeon treats a tendon-related contracture requiring release at that site. Compare 26450 office and facility rates across CMS payment localities in Guam.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 26450 in Guam?
Guam has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$492.01
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Hand surgery
About 26450: Palm flexor tendon tenotomy
Open division of a flexor tendon in the palm is reported when a hand surgeon treats a tendon-related contracture requiring release at that site.
This procedure involves surgically dividing a flexor tendon within the palm to reduce a tendon-related contracture or correct restricted finger position. A hand surgeon typically performs it in an operating room, with the operative report identifying the tendon and palm-level site and describing the reason for division. It differs from freeing a tendon from adhesions: tenotomy divides the tendon, while tenolysis releases tethering around it.
Report the code when the operative work is an open tenotomy of a flexor tendon in the palm, not when the tendon division is at the finger or involves an extensor tendon. Documentation should establish the treated tendon, the palm location, the indication, and the procedure performed. Medicare 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 are subject to the standard 50% reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 26450
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU3.70 · 27%
- Practice expense (office) RVU9.35 · 68%
- Malpractice RVU0.69 · 5%
206
Medicare services in 2024 · #4299 by national volume
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.
26450 compared with similar codes
Office rates for Guam, from the same CMS release.
Compare 26450 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Hawaii, Guam →
Office / nonfacility
Unavailable
Facility
$492.01
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 26450 in Hawaii, Guam.
PPRRVU2026_Oct_nonQPP.csv
2,601
- Code
- 26450
- Physician work
- 3.70
- Practice expense
- 9.35
- Malpractice
- 0.69
GPCI2026.csv
46
- Locality
- Hawaii, Guam
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.70 | × 1.000 | 3.7000 |
| Practice expense | 9.35 | × 1.137 | 10.6310 |
| Malpractice | 0.69 | × 0.579 | 0.3995 |
| Total RVUs | 14.7305 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Hawaii, Guam$492.01
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.7 | 1 |
| Practice expense | 9.35 | 1.137 |
| Malpractice | 0.69 | 0.579 |
(3.7 × 1 + 9.35 × 1.137 + 0.69 × 0.579) × $33.4009 = $492.01
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
26450 billing questions
How is this distinguished from 26455?
This code is for open flexor tendon division in the palm. Code 26455 describes the corresponding tenotomy at the finger.
How is tenotomy different from tenolysis?
Tenotomy divides the tendon; tenolysis frees a tendon from adhesions that restrict its glide. Code 26440 is a nearby flexor tenolysis code.
Should modifier 50 be reported for both hands?
No. Modifier 50 is inappropriate for this code under the CMS bilateral adjustment rule.
What documentation supports reporting this code?
The operative note should identify the flexor tendon and palm-level location, explain the indication for division, and document that an open tenotomy was performed.
What happens when another procedure is performed in the same session?
The highest-valued procedure is paid in full, and other procedures in the same session are subject to the standard multiple procedure reduction.
Can an assistant surgeon or co-surgeon be reported?
Assistant-at-surgery payment requires documentation of medical necessity. Co-surgeons and team surgery are not permitted for this code.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
2,59826442,,Release palm & finger tendon,A,,9.51,17.42,NA,17.42,,1.84,28.77,28.77,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,59926445,,Release hand/finger tendon,A,,4.34,12.94,NA,12.94,,0.83,18.11,18.11,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,60026449,,Release forearm/hand tendon,A,,8.38,9.84,NA,9.84,,1.56,19.78,19.78,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,60126450,,Incision of palm tendon,A,,3.70,9.35,NA,9.35,,0.69,13.74,13.74,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,60226455,,Incision of finger tendon,A,,3.67,9.38,NA,9.38,,0.69,13.74,13.74,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,60326460,,Incise hand/finger tendon,A,,3.49,9.29,NA,9.29,,0.65,13.43,13.43,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,60426471,,Fusion of finger tendons,A,,5.75,12.45,NA,12.45,,1.07,19.27,19.27,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503
4410212,GA,01,ATLANTA,1.003,1.016,1.201
4510212,GA,99,REST OF GEORGIA,1.000,0.892,1.192
4601212,HI,01,"HAWAII, GUAM",1.000,1.137,0.579
4702202,ID,00,IDAHO,1.000,0.920,0.473
4806102,IL,16,CHICAGO,1.007,1.005,2.295
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014