CPT code 26170: Excision of tendon, palm billing guide

Key takeaways

CPT code 26170 describes excision of tendon, palm, flexor or extensor, each tendon, in the AMA’s Musculoskeletal System section.

The code is reported per tendon excised. Multiple tendons removed in the same session each require a separate unit of 26170.

Anatomy decides between 26170 and 26180. The operative note has to state whether the excision happened in the palm or within a finger.

Modifier 51 and the finger-specific F modifiers are the ones that come up most. A wrong or missing modifier is a frequent cause of NCCI edit denials.

Pabau’s claims management software checks each claim for the fields payers require, then submits it electronically through Claim.MD.

CPT code 26170 is a billable code for excision of tendon, palm, flexor or extensor, each tendon. It covers complete removal of a tendon from the palmar region of the hand, and it is reported once for every tendon excised.

Denials on this code usually trace back to the operative note rather than to the surgery itself. Payers need to see which tendon came out, whether it was flexor or extensor, and how many were excised. Medical billing for hand surgery codes starts with getting those details on the page.

What CPT code 26170 covers

The American Medical Association places 26170 in Surgery > Musculoskeletal System > Hand and Fingers > Excision Procedures, within CPT range 26100-26262. That sets it apart from tendon repair and tendon transfer, which describe reconstruction rather than removal.

Clinical context: when is 26170 appropriate?

Surgeons use 26170 when the clinical indication requires complete tendon removal from the palm. Common indications include:

• Giant cell tumor of the tendon sheath.
• Tendon damage from trauma or infection that is too extensive to repair.
• A degenerated tendon that keeps limiting hand function.

The code covers both flexor and extensor tendons in the palm. Flexor tendons run along the palmar surface, while extensor tendons course along the dorsal aspect. Both sit inside the region the code describes, so tendon layer alone never changes the code.

Quantity is what changes the claim. Each tendon excised in the same operative session is reported separately with 26170.

Which modifiers apply to 26170

The modifiers that come up on 26170 are 51, 50, 59, LT, RT, F1 through F9, and 22. Which one applies depends on the clinical scenario. A wrong modifier, or a missing one, is the most common route to a denial on this code.

Modifier 51 reduces payment on the secondary procedure to 50% of the allowed amount for most payers. Some carriers keep modifier 51-exempt lists, so verify before appending it. Medicare’s rules on modifier 51 differ from commercial policies. Confirm the guidelines with your Medicare Administrative Contractor (MAC).

Reimbursement rates and RVUs for 26170

Reimbursement for 26170 varies by payer, geographic location, and whether the procedure happens in a facility or non-facility setting. The figures below reflect 2025 Medicare Physician Fee Schedule (MPFS) national averages. Actual payment depends on the Geographic Practice Cost Index (GPCI) adjustment for each MAC jurisdiction. Always verify current rates with the CMS fee schedule lookup tool.

The FastRVU lookup tool pulls current values directly from CMS data, including the most recent MPFS final rule. RVU values for 26170 change with every annual rule, so cite the data year whenever you document expected reimbursement internally.

Medicare reimbursement and superbill documentation

Medicare pays the lower of the submitted charge or the MPFS allowed amount. For hand surgery practices, accurate superbill documentation captures the tendon count and the operative site. It also records any secondary procedures performed in the same session. Incomplete superbill data delays payment and creates compliance exposure.

After adjudication, Medicare returns a remittance advice showing the allowed amount, the patient’s liability, and any adjustment reason codes. Reviewing those promptly on 26170 claims catches underpayments before the appeal window closes. Practices submitting through the Claim.MD integration can run eligibility checks and code validation before a claim leaves the practice.

NCCI bundling rules for 26170

The National Correct Coding Initiative (NCCI) maintains bundling edit pairs. Each pair governs which two codes may be billed together for the same patient on the same date. Billing two codes that form an NCCI edit pair without an appropriate modifier results in automatic denial of the secondary code.

For 26170, the bundling considerations that matter involve adjacent excision and repair codes covering overlapping anatomical work. When a tendon excision and a second tendon procedure are both performed, the note carries the burden. It must place each at a distinct anatomical site, or describe each as a separately identifiable service. A clearinghouse edit check before submission catches most of these pairs while the claim can still be fixed.

• Modifier 59 (or XS, XU, XE, XP) overrides an NCCI edit when documentation supports a distinct service. Never append it reflexively to push a claim through. The operative report has to carry the clinical justification.
• NCCI tables are updated quarterly. An edit pair that did not exist in Q1 may be active by Q3. Check the current CMS NCCI Policy Manual for the applicable quarter before assuming two codes are independently billable.
• Unbundling carries audit exposure. Consistently billing 26170 with codes that form active NCCI edit pairs, without appropriate modifiers and documentation, constitutes a compliance violation. Coders should flag these patterns for periodic medical billing compliance audits.

The AMA CPT coding resources portal carries CPT Assistant references, which give official guidance on specific procedure scenarios. CMS publishes the NCCI Policy Manual and the quarterly edit files on its own site.

Related CPT codes and when to use them

Several adjacent codes in the hand and finger range are routinely cross-referenced with 26170. Choosing one off an imprecise operative note is a frequent billing error, alongside modifier mistakes. The table below maps each of them to its clinical indication.

The 26170 and 26180 pair causes the most confusion. Anatomy settles it. The palm means 26170, and a finger means 26180. A note that says only “hand tendon excision” leaves the coder guessing between them.

Hand tendon excision turns up in orthopedic and plastic surgery practices alike, and both bill the same descriptor. The one document that decides the code is the operative note, so hold every surgeon in the group to the same wording.

Coding tips to avoid claim denials

Denials on 26170 cluster around three root causes. Documentation is too thin, the modifier is wrong, or the code itself was the wrong pick. Systematic pre-submission checks remove most of the avoidable rejections.

• Document the tendon by name and layer. Name the specific tendon, such as the flexor digitorum profundus to the ring finger. Confirm it was excised rather than released, and state the palmar location. “Tendon removed” will not survive an audit.
• Count and report each tendon separately. If three tendons are excised from the palm in a single session, report 26170 x3. Each unit needs its own operative note entry confirming that tendon was excised. The “each tendon” wording in the descriptor is what supports per-tendon reporting.
• Confirm the global period before billing post-op visits. 26170 carries a 90-day global period. Evaluation and management services in that window need modifier 24 or 79 to be paid separately. Hand therapy delivered by the physical therapy team bills under its own codes.
• Check payer-specific coverage policies before submitting. Some Medicare Administrative Contractors publish Local Coverage Determinations that affect tendon excision procedures. Reviewing the applicable determination before service prevents non-coverage denials.
• Use denial data to identify patterns. Tracking denial codes for 26170 across a 90-day period shows whether the cause is the modifier, the documentation, or payer policy. Each root cause takes a different fix.

Denial management for hand surgery codes should include a quarterly claims audit, comparing billed units of 26170 against the operative notes. A clean claim the first time is far faster than working a denial through the appeals cycle.

How Pabau supports hand surgery billing

In most hand surgery practices, the operative note lives in one system and the claim gets built in another. Someone reads the note, counts the tendons, picks the modifier, and types it all again into a billing tool. Every retype is a chance to lose the detail a payer needs.

Practice management software like Pabau keeps the note, the charge, and the claim inside one patient record. Its claims management software checks each claim for the fields payers require, such as membership numbers and authorization codes. Claims then go out electronically through the Claim.MD integration.

After submission, each claim’s status sits in the same place as the record it came from. When a 26170 claim stalls, the coder can see where it is without opening a separate portal, so the practice gets paid sooner.

Track every hand surgery claim in one place

Pabau checks each claim for the fields payers require, then submits it through Claim.MD and tracks its status in the patient record. Fewer resubmissions, and faster payment.

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Conclusion

26170 rewards a practice that fixes the note rather than the claim. Get the tendon, the layer, and the count into the operative report, and both modifier selection and unit counts follow from what is written. Audit defense follows too.

Pabau’s claims management software checks each claim for the fields payers require before it leaves the practice. It then routes the claim through Claim.MD for electronic submission to thousands of US payers. Book a demo to see how Pabau handles hand surgery billing from note to payment.

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