No office rate
Both entries concern tendon lengthening. Use the applicable CPT descriptor and the operative documentation to identify the correct tendon and procedure.
On this page
CMS RVU26D · Effective 2026-10-01
26478 Tendon lengthening Medicare reimbursement rates in Massachusetts
Reports operative lengthening of a hand tendon when a surgeon increases tendon length to address a documented hand motion or position problem. Compare 26478 office and facility rates across CMS payment localities in Massachusetts.
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 26478 in Massachusetts?
Massachusetts has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$668.63–$736.06
2 of 2 localities have a supported rate.
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 26478: Hand tendon lengthening surgery
Reports operative lengthening of a hand tendon when a surgeon increases tendon length to address a documented hand motion or position problem.
This procedure surgically increases the length of a hand tendon, such as when a shortened or contracted tendon restricts motion or holds a digit in an abnormal position. An orthopedic hand surgeon or plastic surgeon typically performs it in an operating room, often in a hospital or ambulatory surgery center. The operative note should identify the tendon and site, describe the lengthening performed, and explain the functional problem being treated.
Report the code for the documented hand tendon lengthening, not for tendon release, shortening, or transfer. The service has a 90-day global period, which includes the day-before preoperative visit and related postoperative care during that period. 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 reduction. Modifier 50 is inappropriate for this code. Assistant-at-surgery payment requires documented medical necessity; co-surgeon and team-surgery payment are not permitted.
CMS billing rules for 26478
- 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 RVU5.82 · 30%
- Practice expense (office) RVU12.54 · 64%
- Malpractice RVU1.13 · 6%
230
Medicare services in 2024 · #4200 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.
26478 compared with similar codes
Office rates for Massachusetts, from the same CMS release.
No office rate
26478 is for lengthening a hand tendon; 26479 is the hand-tendon shortening entry.
No office rate
26445 describes release of a hand or finger tendon. Choose 26478 when the documented operative work lengthens the tendon.
Compare 26478 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.
2 of 2 payment localities
Metropolitan Boston →
Office / nonfacility
Unavailable
Facility
$736.06
Rest Of Massachusetts →
Office / nonfacility
Unavailable
Facility
$668.63
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26478 billing questions
How does this differ from 26479?
26478 reports tendon lengthening; 26479 is the hand-tendon shortening entry. Match the code to the direction of the operation documented in the operative report.
How does this differ from 26445?
26478 describes increasing tendon length. Code 26445 is a tendon-release procedure, rather than lengthening the tendon.
Does the 90-day global period include postoperative care?
Yes. The global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can modifier 50 be used for bilateral hand tendon lengthening?
No. CMS identifies the descriptor or anatomy as unsuitable for bilateral adjustment, so modifier 50 is inappropriate for this code.
When is an assistant-at-surgery payable?
Payment for an assistant at surgery requires documentation of medical necessity. Co-surgeon and team-surgery payment are not permitted for this code.
What documentation supports reporting 26478?
Document the tendon and hand site, the lengthening technique or work performed, and the functional restriction or abnormal position being treated.
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.
2,60526474,,Fusion of finger tendons,A,,5.35,13.12,NA,13.12,,1.14,19.61,19.61,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,60626476,,Tendon lengthening,A,,5.22,13.07,NA,13.07,,1.12,19.41,19.41,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,60726477,,Tendon shortening,A,,5.19,12.20,NA,12.20,,0.99,18.38,18.38,0,090,0.10,0.69,0.21,2,0,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,60826478,,Lengthening of hand tendon,A,,5.82,12.54,NA,12.54,,1.13,19.49,19.49,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,60926479,,Shortening of hand tendon,A,,5.76,13.25,NA,13.25,,1.23,20.24,20.24,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,61026480,,Transplant hand tendon,A,,8.78,9.56,NA,9.56,,1.66,20.00,20.00,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,61126483,,Transplant/graft hand tendon,A,,8.27,15.16,NA,15.16,,1.57,25.00,25.00,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00