Billing code 26160: Tendon sheath excisionMedicare rate & RVUs in Oregon
Reports surgical removal of a lesion arising from a hand or finger tendon sheath or joint capsule, such as a ganglion or cyst.
Medicare pays $649.04–$711.53 for 26160 in the office in Oregon, from Rest Of Oregon to Portland. Which amount applies depends on the service address.
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 26160 covers
A hand surgeon removes a lesion attached to a tendon sheath or joint capsule in the hand or finger. A common example is a ganglion arising from a finger tendon sheath; cystic or other localized lesions may also be treated. The service is typically performed by an orthopedic or plastic surgeon in an operating room or ambulatory surgery setting, with the lesion separated from the involved sheath or capsule and removed.
Select this code when the operative findings identify the lesion as arising from the tendon sheath or joint capsule, rather than as a separate superficial or deep soft-tissue mass. Document the involved structure, location, lesion, and excision. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 is inappropriate; assistant-at-surgery payment is statutorily restricted, and co-surgeons and team surgery 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.
Where 26160 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | $711.53 | $323.75 |
| Rest Of Oregon | $649.04 | $301.40 |
How the 26160 rate is calculated
Each of 26160’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 · 26160
RVUs × geographic indexes × conversion factor
Work3.48
3.48 RVUs× 1.000 GPCI
Practice expense15.55
15.55 RVUs× 1.000 GPCI
Malpractice0.66
0.66 RVUs× 1.000 GPCI
Adjusted RVUs
19.6900
Conversion factor
$33.4009
Medicare rate
$657.66
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 26160
26160 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 26160
Tendon sheath excision
| 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) | 1 | Not paid (statutory restriction). |
| 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 · 26160
Tendon sheath excision
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
26160 without 51 · national office
$657.66
Tendon sheath excision
26160-51 · Second procedure: 50%
$328.83
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%).
26160 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 26111Hand mass excision
- This code targets a lesion arising from a tendon sheath or joint capsule. 26111 is for a subcutaneous hand lesion meeting its size criterion.
- 26113Hand tumor excision
- Use this code for a sheath- or capsule-based lesion. 26113 addresses a deep hand tumor meeting its size criterion.
- 26145Tenosynovectomy
- 26145 involves excision of a tendon in the palm or finger. This code removes a lesion arising from the tendon sheath or joint capsule, not the tendon itself.
26160 billing questions
How is this different from excision of a hand soft-tissue mass?
Use this code when the lesion arises from a tendon sheath or joint capsule. Codes for hand masses are selected according to the mass's tissue plane and, for some codes, size.
Can a ganglion from a finger tendon sheath be reported with this code?
Yes, when the surgeon excises a ganglion arising from the tendon sheath. The operative note should identify the origin and the structure from which it was removed.
Should modifier 50 be used for lesions on both hands?
No. CMS identifies bilateral adjustment as inappropriate for this code.
How does the 90-day global period affect postoperative visits?
The day-before preoperative visit and 90 days of related postoperative care are included in the global period.
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. Medicare does not pay an assistant at surgery for this code, and 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 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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