Billing code 26478: Tendon lengtheningMedicare rate & RVUs in Nevada
Reports operative lengthening of a hand tendon when a surgeon increases tendon length to address a documented hand motion or position problem.
CMS doesn’t publish an office rate for 26478 in Nevada.
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 26478 covers
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.
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 in Nevada**
| Payment locality | Office | Facility |
|---|---|---|
| Nevada** | Unavailable | $645.10 |
How the 26478 rate is calculated
Each of 26478’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 · 26478
RVUs × geographic indexes × conversion factor
Work5.82
5.82 RVUs× 1.000 GPCI
Practice expense12.54
12.54 RVUs× 1.000 GPCI
Malpractice1.13
1.13 RVUs× 1.000 GPCI
Adjusted RVUs
19.4900
Conversion factor
$33.4009
Medicare rate
$650.98
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 26478
26478 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 26478
Tendon lengthening
| 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) | 0 | Not paid without supporting documentation. |
| 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 · 26478
Tendon lengthening
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
26478 without 51 · national facility
$650.98
Tendon lengthening
26478-51 · Second procedure: 50%
$325.49
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%).
26478 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 26476Tendon lengthening
- Both entries concern tendon lengthening. Use the applicable billing code descriptor and the operative documentation to identify the correct tendon and procedure.
- 26479Tendon shortening
- 26478 is for lengthening a hand tendon; 26479 is the hand-tendon shortening entry.
- 26445Tendon release
- 26445 describes release of a hand or finger tendon. Choose 26478 when the documented operative work lengthens the tendon.
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 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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