No office rate
Both concern thumb extensor tendon reconstruction; 26492 applies when the reconstruction uses a free graft.
On this page
CMS RVU26D · Effective 2026-10-01
26490 Thumb tendon repair Medicare reimbursement rates in New Jersey
Reconstructs a thumb extensor tendon without a free graft, typically when a damaged or deficient tendon requires operative restoration. Compare 26490 office and facility rates across CMS payment localities in New Jersey.
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 26490 in New Jersey?
New Jersey 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
$882.61–$920.12
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 26490: Thumb extensor tendon reconstruction without graft
Reconstructs a thumb extensor tendon without a free graft, typically when a damaged or deficient tendon requires operative restoration.
This code describes reconstruction of an extensor tendon in the thumb without using a free tendon graft. A hand surgeon may perform the procedure when an injury or chronic tendon problem leaves the extensor mechanism unable to extend the thumb normally and reconstruction is feasible without graft tissue. It is generally performed in an operating room, often in a hospital outpatient or ambulatory surgery setting.
Report the code when the operative work reconstructs the thumb extensor tendon and does not use a free graft; a graft-based reconstruction is represented by a different code. The operative report should identify the affected tendon, the defect or dysfunction, the reconstructive method, and whether graft tissue was used. CMS 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 multiple-procedure reduction. Modifier 50 is inappropriate for this code. Assistant-at-surgery payment requires documented medical necessity; co-surgeon and team-surgery billing are not permitted.
CMS billing rules for 26490
- 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 RVU8.39 · 34%
- Practice expense (office) RVU14.43 · 59%
- Malpractice RVU1.77 · 7%
73
Medicare services in 2024 · #5116 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.
26490 compared with similar codes
Office rates for New Jersey, from the same CMS release.
No office rate
26494 addresses reconstruction of a thumb flexor tendon without a free graft, rather than an extensor tendon.
No office rate
26496 is for thumb flexor tendon reconstruction with a free graft; this code is for extensor tendon reconstruction without one.
No office rate
26480 describes tendon transfer or transplant in the hand dorsum or carpometacarpal area, rather than reconstruction of a thumb extensor tendon without a free graft.
Compare 26490 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
Northern Nj →
Office / nonfacility
Unavailable
Facility
$920.12
Rest Of New Jersey →
Office / nonfacility
Unavailable
Facility
$882.61
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26490 billing questions
How does this code differ from 26492?
This code describes thumb extensor tendon reconstruction without a free graft. Code 26492 is the related option when a free graft is used.
How does this differ from 26494?
Code 26494 is for reconstruction of a thumb flexor tendon without a free graft. Select based on whether the reconstructed tendon is an extensor or flexor tendon.
What documentation supports reporting this code?
Document the thumb extensor tendon involved, the tendon defect or dysfunction, the reconstructive work performed, and whether free graft tissue was used.
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?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
When is assistant-at-surgery payment allowed?
CMS allows assistant-at-surgery payment only when medical necessity is documented. Co-surgeons and team surgery 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 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.
2,61126483,,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
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