No office rate
Both concern tendon work in the palm; the deciding feature is whether a free graft is used. This code is for the grafted procedure, while 26485 is for the procedure without one.
On this page
CMS RVU26D · Effective 2026-10-01
26489 Tendon transfer Medicare reimbursement rates in Massachusetts
Reports graft-assisted rerouting of a tendon in the palm to restore hand motion or improve tendon balance when reconstruction requires a free graft. Compare 26489 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 26489 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
$961.01–$1053.11
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 26489: Palm tendon transfer with free graft
Reports graft-assisted rerouting of a tendon in the palm to restore hand motion or improve tendon balance when reconstruction requires a free graft.
A hand surgeon uses a free tendon graft to reroute or reconstruct a tendon in the palm when the existing tendon cannot provide the needed motion or balance. The service may be part of reconstructive surgery for tendon loss, rupture, or functional imbalance. The operative report should identify the tendon and palm site, explain the transfer or reconstruction, and document use of a free graft.
Select this code for the palm procedure that uses a free graft, rather than the palm procedure without one or a graft procedure at another hand site. The graft procurement is included in this service. Medicare assigns 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 the others are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate for this palm-specific service. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 26489
- 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 RVU9.61 · 34%
- Practice expense (office) RVU16.50 · 59%
- Malpractice RVU2.05 · 7%
45
Medicare services in 2024 · #5412 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.
26489 compared with similar codes
Office rates for Massachusetts, from the same CMS release.
No office rate
This code identifies the palm site. Code 26483 is the related grafted tendon procedure for the hand site; use the code that matches the documented operative location.
No office rate
Code 26440 describes release of a palm or finger tendon, not graft-assisted tendon rerouting or reconstruction.
Compare 26489 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
$1053.11
Rest Of Massachusetts →
Office / nonfacility
Unavailable
Facility
$961.01
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26489 billing questions
How is this code distinguished from 26485?
Both describe a tendon procedure in the palm, but this code involves a free graft. Use 26485 when the palm procedure is performed without a free graft.
Can the tendon graft harvest be billed separately?
Graft procurement is included in this service. The operative note should document the graft and its role in the palm tendon reconstruction.
What documentation supports reporting this code?
Document the tendon and palm site, the rerouting or reconstruction performed, and the use of a free tendon graft. The record should make clear why the graft was needed.
How many units should be reported?
The service is reported per tendon. Identify each treated tendon in the operative documentation and follow applicable claim instructions for units.
Can modifier 50 be used when both hands are treated?
Modifier 50 is inappropriate for this palm-specific service. The CMS rule for this code does not provide a bilateral adjustment.
What payment rules affect the surgical claim?
The code has a 90-day global period. In a same-session multiple-procedure claim, the highest-valued procedure is paid in full and other procedures are subject to the standard reduction; assistant payment requires medical-necessity documentation.
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.
2,61026480,,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
2,61226485,,Transplant palm tendon,A,,7.69,15.00,NA,15.00,,1.47,24.16,24.16,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,61326489,,Transplant/graft palm tendon,A,,9.61,16.50,NA,16.50,,2.05,28.16,28.16,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,61426490,,Revise thumb tendon,A,,8.39,14.43,NA,14.43,,1.77,24.59,24.59,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,61526492,,Tendon transfer with graft,A,,9.59,15.38,NA,15.38,,2.05,27.02,27.02,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,61626494,,Hand tendon/muscle transfer,A,,8.44,14.44,NA,14.44,,1.79,24.67,24.67,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00