No office rate
Both concern thumb tendon transfer. Use 26492 when the reconstruction uses a free tendon graft; use 26490 when it does not.
On this page
CMS RVU26D · Effective 2026-10-01
26492 Tendon transfer Medicare reimbursement rates in Massachusetts
Reports thumb tendon reconstruction that uses a free tendon graft to reroute tendon function when the native tendon cannot restore useful motion. Compare 26492 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 26492 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
$920.94–$1007.75
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 26492: Thumb tendon transfer with free graft
Reports thumb tendon reconstruction that uses a free tendon graft to reroute tendon function when the native tendon cannot restore useful motion.
An orthopedic or hand surgeon uses a free tendon graft to reconstruct a thumb tendon pathway, redirecting tendon force to restore useful thumb motion when the native tendon is deficient. The procedure is typically performed in an operating room for reconstructive problems such as tendon loss or rupture. The operative work includes placing and attaching the graft as part of the thumb tendon reconstruction. This code distinguishes a graft-based thumb procedure from tendon transfer without a graft and from graft procedures at other hand sites.
The operative report should identify the thumb tendon or functional deficit, use of a free graft, and the transfer route and attachments. CMS assigns a 90-day major-surgery global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in the same session, the highest-valued procedure is paid in full and the others are subject to the standard 50% reduction. Modifier 50 is inappropriate. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 26492
- 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 may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU9.59 · 35%
- Practice expense (office) RVU15.38 · 57%
- Malpractice RVU2.05 · 8%
79
Medicare services in 2024 · #5058 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.
26492 compared with similar codes
Office rates for Massachusetts, from the same CMS release.
No office rate
This code is specific to the thumb. Code 26483 describes the graft-based tendon procedure at the carpometacarpal area or dorsum of the hand.
No office rate
This code is for the thumb, while 26489 describes a graft-based tendon procedure at the palm.
No office rate
Both involve a free tendon graft, but 26492 is for the thumb and 26498 is for a finger.
Compare 26492 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
$1007.75
Rest Of Massachusetts →
Office / nonfacility
Unavailable
Facility
$920.94
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26492 billing questions
How does this differ from 26490?
This code is for a thumb tendon reconstruction that uses a free tendon graft. Code 26490 is the related thumb procedure without a free tendon graft.
How is it distinguished from graft procedures for other hand sites?
Choose this code when the reconstructed tendon is in the thumb. Codes 26483 and 26489 describe graft procedures at the dorsum or palm, while 26498 is for a finger.
Can modifier 50 be used for both thumbs?
No. CMS identifies bilateral adjustment as inappropriate for this code; modifier 50 should not be used.
What postoperative care is included in the global period?
The 90-day major-surgery global period includes the day-before preoperative visit and 90 days of related postoperative care.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction when performed in the same session.
May an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team surgery is 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 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.
2,61226485,,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
2,61726496,,Revise thumb tendon,A,,9.54,14.79,NA,14.79,,2.04,26.37,26.37,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,61826497,,Finger tendon transfer,A,,9.52,14.78,NA,14.78,,2.04,26.34,26.34,0,090,0.10,0.69,0.21,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00