Billing code 26357: Flexor tendon repairMedicare rate & RVUs in Texas
Reports secondary repair of a flexor tendon in finger zone II, without a free graft, when the surgeon addresses an earlier tendon injury.
CMS doesn’t publish an office rate for 26357 in Texas.
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 26357 covers
This code is for secondary repair or advancement of a flexor tendon in zone II of a finger, without a free tendon graft. It is generally performed by a hand, orthopedic, or plastic surgeon in an operating room when the tendon injury is being treated as a secondary repair rather than a primary repair. The operative note should identify the affected tendon and finger, the zone, and the secondary nature of the repair. A repair that uses a free graft follows a different code path.
Report the code for each tendon repaired, with documentation supporting zone II, secondary repair, and the absence of a free graft. The service has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Bilateral adjustment is inappropriate. Assistant-at-surgery payment may be made; 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 26357 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | Unavailable | $869.72 |
| Beaumont | Unavailable | $810.29 |
| Brazoria | Unavailable | $835.74 |
| Dallas | Unavailable | $844.13 |
| Fort Worth | Unavailable | $840.93 |
| Galveston | Unavailable | $840.23 |
| Houston | Unavailable | $881.96 |
| Rest Of Texas | Unavailable | $824.64 |
How the 26357 rate is calculated
Each of 26357’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 · 26357
RVUs × geographic indexes × conversion factor
Work10.73
10.73 RVUs× 1.000 GPCI
Practice expense12.54
12.54 RVUs× 1.000 GPCI
Malpractice2.28
2.28 RVUs× 1.000 GPCI
Adjusted RVUs
25.5500
Conversion factor
$33.4009
Medicare rate
$853.39
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 26357
26357 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 26357
Flexor tendon repair
| 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) | 2 | Paid. |
| 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 · 26357
Flexor tendon repair
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
26357 without 51 · national facility
$853.39
Flexor tendon repair
26357-51 · Second procedure: 50%
$426.70
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%).
26357 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 26358Hand tendon repair
- Both describe secondary zone II flexor tendon repair. Choose 26358 when the surgeon uses a free graft; this code is for repair without one.
- 26352Tendon repair
- 26352 describes primary zone II repair without a free graft. This code applies when the repair is secondary.
- 26356Flexor tendon repair
- 26356 describes primary zone II repair with a free graft. This code is for secondary repair without a free graft.
26357 billing questions
How does this differ from a primary flexor tendon repair?
This code is for a secondary repair in zone II. Use a primary-repair code when the procedure is documented as primary, selecting the code that matches the zone and graft use.
When is a graft code used instead?
Use the corresponding secondary-repair code when the surgeon uses a free tendon graft. This code describes secondary repair without a free graft.
How many units are reported when more than one tendon is repaired?
The code is reported for each tendon repaired. The operative report should identify the tendons treated and support the applicable zone and repair type.
Can modifier 50 be used for repairs on both hands?
No. CMS identifies bilateral adjustment as inappropriate for this code; the descriptor or anatomy makes modifier 50 unsuitable.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
May an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. 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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