CPT 26390: Flexor Tendon Synthetic Rod Implant
CPT code 26390 identifies a surgical implant procedure in which a synthetic rod is placed in the flexor tendon sheath of a finger or hand to facilitate subsequent tendon graft harvesting. The code is reported once per rod implant and applies to procedures performed in operative settings, typically ambulatory surgical centers and hospital operating rooms. Nationally, this code is relevant to hand surgeons, orthopedic and plastic surgery practices, and facilities managing reconstructive tendon repair pathways. Key payers in the national landscape include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find a concise explanation of the clinical intent of the code, common sites of service, and which major payers commonly adjudicate claims for this service. The publication presents benchmarks and policy context relevant to reimbursement and billing practice, outlines typical service-line considerations for surgical hand procedures, and flags areas where claims documentation and coding specificity affect payment. Data not available in the input is noted where applicable.
Sign up for cpt 26390 policy alerts
Get alerted when payer policies referencing 26390 are released or updated.
Billing Code Overview
CPT code 26390 describes a surgical procedure in which the provider makes an incision over a flexor tendon in a patient’s finger or hand to place a synthetic rod intended to occupy the tendon sheath for later tendon graft harvesting. This is a surgical implant procedure performed on the fingers or hand.
-
Service type: Surgical implant preparation for future tendon grafting
-
Typical site of service: Ambulatory surgical center or hospital operating room
Clinical & Coding Specifications
Clinical Context
A 45-year-old patient presents with chronic flexor tendon scarring in the finger after a previous laceration and repair, resulting in loss of tendon glide and severe functional limitation. The hand surgeon plans a two-stage flexor tendon reconstruction: first-stage placement of a silicone tendon rod to create a pseudotendon sheath and maintain tendon length, allowing finger mobilization while soft tissues recover; second-stage tendon grafting will occur later when the bed is suitable. The procedure involves a focused incision over the affected flexor tendon sheath in the finger/hand, blunt dissection to the flexor sheath, insertion and placement of a synthetic rod (reported once per rod with 26390), closure of skin, and application of a dorsal blocking splint. Typical workflow includes preoperative evaluation in the clinic, informed consent, preoperative anesthesia evaluation, procedure in an ambulatory surgery center or hospital outpatient department under regional block or general anesthesia, postoperative hand therapy planning, and scheduled second-stage tendon grafting once the rod has established a gliding surface.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
RT | Right side | When the rod is implanted in a right finger/hand |
LT | Left side | When the rod is implanted in a left finger/hand |
59 | Distinct procedural service | When this procedure is separate and independent from another procedure performed at the same session (if not captured by other specific modifiers) |
51 | Multiple procedures | When 26390 is billed with other distinct procedures during the same operative session to indicate multiple procedures were performed |
52 | Reduced services | When the procedure is partially reduced or not completed as originally planned |
53 | Discontinued procedure | When the procedure is started but discontinued due to unforeseen circumstances |
22 | Increased procedural services | When service requires substantially greater work than typical for 26390 (document justification) |
76 | Repeat procedure by same physician | When the same physician performs the same procedure again on the same day (note: not in provided list; use 77 alternatives are not allowed) |
78 | Unplanned return to the operating room by the same physician following initial procedure for a related procedure during the postoperative period | When the patient returns to the OR for a complication related to the initial implantation |
80 | Assistant surgeon | When an assistant surgeon participates in the procedure |
81 | Minimum assistant surgeon | When a minimal assistant surgeon role is documented |
62 | Two surgeons | When two surgeons with different specialties work together as primary surgeons |
26 | Professional component | If a billing split requires reporting the professional component separately (rare for this procedure) |
TC | Technical component | For reporting only the technical component if facility billing requires separation |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207L00000X | Orthopedic Surgery | Most common specialty performing flexor tendon reconstruction and first-stage silicone rod placement |
| 207X00000X | Hand Surgery (Orthopedic) | Subspecialty designation for surgeons focusing on hand procedures; frequently performs 26390 |
| 207RH0000X | Plastic Surgery | Plastic and reconstructive hand surgeons commonly perform staged tendon reconstruction |
| 261QU0200X | Physical Therapist | Provides postoperative hand therapy and tendon-gliding protocols (included as clinical team specialty) |
| 3336C0002X | Occupational Therapist | Delivers hand rehabilitation and splinting after rod placement |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
M66.4 | Spontaneous rupture of flexor tendons | Indicates tendon discontinuity that may require staged reconstruction with a silicon rod to prepare the bed for grafting |
S66.301A | Unspecified injury of flexor muscle, fascia and tendon of right thumb at wrist and hand level, initial encounter | Traumatic injuries to flexor tendons commonly lead to staged repair with rod placement when primary repair is not feasible |
S66.302A | Unspecified injury of flexor muscle, fascia and tendon of left thumb at wrist and hand level, initial encounter | Left-sided equivalent for traumatic flexor tendon injury scenarios requiring staged approach |
M24.2 | Disorder of ligament, not elsewhere classified | Chronic adhesions and scarring around flexor tendons contributing to loss of glide; rod used to restore gliding surface |
M67.8 | Other specified disorders of synovium and tendon | Encompasses tenosynovitis with significant structural damage where staged reconstruction may be indicated |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
26055 | Tenolysis, flexor tendon, with or without free graft, finger, each tendon | Performed during second-stage procedures to free adhesions if present before or during tendon grafting following 26390 |
26356 | Tenolysis, flexor tendon, forearm and/or wrist, each tendon | Used if more proximal tenolysis is required in staged reconstruction workflows involving the hand/fingers |
26440 | Reconstruction, extensor tendon, finger, primary or secondary; with graft (includes obtaining graft) | Related reconstruction code for extensor system when concomitant procedures are needed in complex hand injuries (adjunct to flexor work) |
25320 | Repair, flexor tendon, forearm and/or wrist, each tendon, primary or secondary | Primary tendon repairs that may precede or follow staged reconstruction when direct repair is possible |
29515 | Application of short arm splint (forearm to hand); static | Typical postoperative immobilization method after 26390 to protect the implant and soft tissues |
20660 | Drainage, hematoma or fluid collection, open; complicated | May be performed if postoperative hematoma or seroma develops requiring operative drainage after rod placement |