Billing code 26489: Tendon transferMedicare rate & RVUs in Texas
Reports graft-assisted rerouting of a tendon in the palm to restore hand motion or improve tendon balance when reconstruction requires a free graft.
CMS doesn’t publish an office rate for 26489 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 26489 covers
A hand surgeon uses a free tendon graft to reroute or reconstruct a tendon in the palm when the existing tendon cannot provide the needed motion or balance. The service may be part of reconstructive surgery for tendon loss, rupture, or functional imbalance. The operative report should identify the tendon and palm site, explain the transfer or reconstruction, and document use of a free graft.
Select this code for the palm procedure that uses a free graft, rather than the palm procedure without one or a graft procedure at another hand site. The graft procurement is included in this service. Medicare assigns 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 the others are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate for this palm-specific service. Assistant-at-surgery payment requires documented medical necessity; 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 26489 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 | $965.37 |
| Beaumont | Unavailable | $886.11 |
| Brazoria | Unavailable | $923.11 |
| Dallas | Unavailable | $931.53 |
| Fort Worth | Unavailable | $926.91 |
| Galveston | Unavailable | $927.50 |
| Houston | Unavailable | $965.02 |
| Rest Of Texas | Unavailable | $905.82 |
How the 26489 rate is calculated
Each of 26489’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 · 26489
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 9.61Practice expense 16.50Malpractice 2.05
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 26489
26489 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 26489
Tendon transfer
| 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 · 26489
Tendon transfer
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
26489 without 51 · national facility
$940.57
Tendon transfer
26489-51 · Second procedure: 50%
$470.29
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%).
26489 compared with similar codes
Compare codes
26489 vs 26485 vs 26483 vs 26440: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 26485Tendon transfer
- Both concern tendon work in the palm; the deciding feature is whether a free graft is used. This code is for the grafted procedure, while 26485 is for the procedure without one.
- 26483Tendon transfer
- This code identifies the palm site. Code 26483 is the related grafted tendon procedure for the hand site; use the code that matches the documented operative location.
- 26440Flexor tenolysis
- Code 26440 describes release of a palm or finger tendon, not graft-assisted tendon rerouting or reconstruction.
26489 billing questions
How is this code distinguished from 26485?
Both describe a tendon procedure in the palm, but this code involves a free graft. Use 26485 when the palm procedure is performed without a free graft.
Can the tendon graft harvest be billed separately?
Graft procurement is included in this service. The operative note should document the graft and its role in the palm tendon reconstruction.
What documentation supports reporting this code?
Document the tendon and palm site, the rerouting or reconstruction performed, and the use of a free tendon graft. The record should make clear why the graft was needed.
How many units should be reported?
The service is reported per tendon. Identify each treated tendon in the operative documentation and follow applicable claim instructions for units.
Can modifier 50 be used when both hands are treated?
Modifier 50 is inappropriate for this palm-specific service. The CMS rule for this code does not provide a bilateral adjustment.
What payment rules affect the surgical claim?
The code has a 90-day global period. In a same-session multiple-procedure claim, the highest-valued procedure is paid in full and other procedures are subject to the standard reduction; assistant payment requires medical-necessity documentation.
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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