Billing code 26416: Tendon graftMedicare rate & RVUs in Illinois
Reports graft-based reconstruction of a hand or finger tendon when the operative repair requires tendon graft tissue rather than direct tendon repair.
CMS doesn’t publish an office rate for 26416 in Illinois.
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 9 sections
What 26416 covers
A hand surgeon uses tendon graft tissue to reconstruct a damaged or deficient tendon in the hand or finger. This may be needed when trauma, tendon loss, or chronic damage leaves a gap or tissue that cannot be managed with a direct repair. The procedure is generally performed in an operating room by an orthopedic or plastic surgeon with hand-surgery expertise. The operative note should identify the tendon and site, the defect or damage being addressed, and the graft-based reconstruction performed.
Report the code when the documented procedure matches graft reconstruction, rather than a repair performed without graft tissue or an excision alone. Documentation should support the tendon involved, graft use, and the surgical work 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 other procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery, and co-surgeon and team-surgery billing 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 26416 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | Unavailable | $987.57 |
| East St. Louis | Unavailable | $922.63 |
| Rest Of Illinois | Unavailable | $889.17 |
| Suburban Chicago | Unavailable | $964.41 |
How the 26416 rate is calculated
Each of 26416’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 · 26416
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 9.32Practice expense 15.56Malpractice 1.98
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 26416
26416 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 26416
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) | 1 | Not paid (statutory restriction). |
| 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 · 26416
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
26416 without 51 · national facility
$897.15
Tendon graft
26416-51 · Second procedure: 50%
$448.58
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%).
26416 compared with similar codes
Compare codes
26416 vs 26410 vs 26412 vs 26418 vs 26420: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 26410Hand tendon repair
- This code concerns graft-based reconstruction of a hand or finger tendon. Use 26410 when the documented hand tendon procedure matches its repair service instead.
- 26412Tendon repair
- Both codes concern hand tendon work involving repair or grafting. Choose based on the exact procedure documented and the code descriptor that matches it.
- 26418Finger tendon repair
- This code describes a finger tendon repair option. Use 26416 when the operative report supports the graft-based reconstruction represented by this code.
- 26420Tendon repair
- This is a neighboring finger tendon repair or graft code. Distinguish it from 26416 using the specific procedure performed and documented.
26416 billing questions
How does this differ from a tendon repair code?
Use this code for the graft-based reconstruction described by the operative report. A repair code applies when the documented work matches that repair procedure rather than this graft reconstruction.
Can the graft be billed separately?
The code represents the graft-based tendon procedure. Do not report a separate service for the graft work that is included in that procedure.
Should modifier 50 be used for both hands?
No. CMS identifies bilateral adjustment as inappropriate for this code; modifier 50 should not be used.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant surgeon or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this code. Co-surgeon and team-surgery billing 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
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