CPT 26433 Extensor Tendon Repair Reimbursement | OpenPayer

Summary & Overview

CPT 26433: Open Repair of Distal Extensor Tendon Insertion

CPT code 26433 denotes an open surgical repair of the distal insertion of an extensor tendon using sutures without a graft. This code captures a focused operative procedure intended to restore tendon function and prevent deformity-related complications. Nationally, accurate coding for distal extensor tendon repairs affects surgical quality reporting, facility utilization metrics, and payer coverage determinations for hand and wrist procedures.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find context on clinical purpose and typical sites of service, common modifiers associated with the service line, and what is available about coding practices for this specific tendon repair. The publication highlights benchmarking considerations, payer coverage patterns, and clinical context relevant to hand surgeons, coding professionals, and revenue cycle staff.

This summary provides a concise reference for clinical coders and practice managers who need to classify this surgical service correctly for claims submission and reporting. Data not available in the input are noted where applicable; the focus remains on the code definition, clinical intent, and the payer universe covered in this analysis.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare26433CPTtendon repairhand surgeryoperative procedureambulatory surgerysurgical codingrevenue cycle

Billing Code Overview

CPT code 26433 describes an open repair of the distal insertion of the extensor tendon with sutures without tendon graft. The procedure is performed to restore extensor tendon continuity at its distal insertion and to prevent progressive deformity and complications.

Service type: Surgical repair (open tendon repair)

Typical site of service: Hospital operating room or ambulatory surgery center

Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.

Clinical & Coding Specifications

Clinical Context

A 42-year-old right-hand–dominant construction worker presents after a door slamming injury to the dorsal distal phalanx of the ring finger 10 days earlier. The patient reports inability to actively extend the fingertip and pain with palpation at the distal extensor tendon insertion. Physical exam demonstrates loss of active terminal interphalangeal extension consistent with a distal extensor tendon avulsion (mallet-type injury) without open contamination. Imaging (lateral finger radiograph) shows a small avulsion fragment without subluxation. The surgeon elects an open repair of the distal extensor tendon insertion using sutures without graft to restore extensor mechanism continuity and prevent chronic deformity.

Typical clinical workflow:

Preoperative evaluation in hand clinic with history, focused exam, and radiographs.
Consent discussion describing risks, benefits, and alternatives; pre-op anesthesia evaluation (regional block or general) and surgical site marking.
Procedure performed in an ambulatory surgery center or hospital outpatient department under sterile conditions; open approach to distal extensor insertion with primary tendon suture repair, irrigation, and layered closure.
Postoperative immobilization in a dorsal splint or cast with arranged hand therapy follow-up and wound checks; activity restrictions and return-to-work planning documented.
Coding and billing reflect the primary service: 26433 (open repair, distal extensor tendon insertion, sutures, no graft).

Coding Specifications

CPT 26460: Open Extensor Tenotomy of Hand or Finger

CPT-26412-EXTENSOR-TENDON-REPAIR-FREE-GRAFT-HAND

CPT 26412: Extensor Tendon Repair with Free Graft, Hand

CPT-26530-METACARPAL-EXCISION-WITH-SOFT-TISSUE-SPACER

CPT 26530: Metacarpal Excision with Soft Tissue Spacer

CPT-26492-OPPONENSPLASTY-TENDON-TRANSFER-GRAFT-THUMB-OPPOSITION

CPT 26492: Opponensplasty, Tendon Transfer with Graft to Restore Thumb Opposition

CPT-26525-FINGER-JOINT-CAPSULE-RELEASE

CPT 26525: Release of Finger Joint Capsule

CPT-26590-MACRODACTYLIA-REPAIR-DIGIT-REDUCTION

CPT 26590: Repair of Macrodactylia, Digit Reduction

CPT-26497-TENDON-TRANSFER-INTRINSIC-HAND-RECONSTRUCTION

CPT 26497: Tendon Transfer for Intrinsic Hand Reconstruction

CPT-26490-OPPONENSPLASTY-TENDON-TRANSFER-THUMB-OPPOSITION

CPT 26490: Opponensplasty, Tendon Transfer to Restore Thumb Opposition

CPT-26498-TENDON-TRANSFER-CLAW-HAND-DEFORMITY-RESTORATION

CPT 26498: Tendon Transfer to Restore Intrinsic Function of All Four Fingers

CPT-26426-CENTRAL-SLIP-REPAIR-BOUTONNIERE-DEFORMITY

CPT 26426: Central Slip Repair for Boutonniere Deformity

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Taxonomy Code	Specialty	Notes
`207L00000X`	Orthopedic Hand Surgery	Orthopedic surgeons with hand subspecialty commonly perform distal extensor tendon repairs.
`207W00000X`	Orthopedic Surgery	General orthopedic surgeons perform tendon repairs of the hand and digits.
`207P00000X`	Plastic Surgery	Plastic surgeons specializing in hand surgery perform primary extensor tendon repairs.
`2084P0800X`	General Practice — Family Medicine	In rural or urgent settings, family medicine or emergency physicians may perform initial assessment and referral; definitive repair usually by specialists.
`2085R0202X`	General Surgery	General surgeons occasionally perform hand procedures in settings without dedicated hand specialists.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S66.511A`	Strain of extensor muscle, right hand, initial encounter	Common diagnosis for extensor tendon injuries of the hand; justifies repair of distal extensor insertion.
`S66.512A`	Strain of extensor muscle, left hand, initial encounter	Same as above for left-sided injuries.
`S60.231A`	Partial traumatic amputation of right index finger with damage to other structures, initial encounter	Traumatic dorsal injuries with tendon involvement may require extensor repair; applicable when tendon avulsion accompanies complex finger trauma.
`S60.311A`	Open bite of right finger(s), initial encounter	Open injuries to the finger with tendon damage often require operative repair.
`S64.011A`	Injury of hand, unspecified, initial encounter	General injury code used when more specific code not documented; may be used in conjunction with tendon repair coding.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`26055`	Repair, flexor tendon, primary or secondary, hand or finger, single tendon; zone I (flexor digitorum profundus)	Alternative tendon repair procedure for flexor injuries; contrasted with `26433` which is an extensor insertion repair.
`26418`	Repair, tendon or muscle, primary; extensor tendon, hand or finger (other than distal insertion)	Repairs of extensor tendons at locations other than the distal insertion; may be performed if injury involves a different tendon segment.
`26440`	Repair, flexor tendon, primary, each additional tendon (same digit)	Represents additional tendon repair when multiple tendons are repaired during the same operative session; used in combination billing scenarios.
`26010`	Fasciotomy, palmar and/or digital	Procedures to relieve compartment or pressure in the digit; may be performed in cases with associated compartment issues.
`26416`	Repair, tendon or muscle, primary; extensor tendon, wrist or forearm	For more proximal extensor tendon repairs when the injury extends beyond the finger; may be performed in the same operative episode if indicated.

`51`	Multiple Procedures	When additional unrelated procedures are performed during the same operative session and payer requires modifier for multiple procedure logic.
`59`	Distinct Procedural Service	When a separate, distinct procedure or service is performed on the same day that is not incidental to `26433`.
`76`	Repeat Procedure by Same Physician	Data not available in the input.
`RT`	Right side	When the procedure is performed on the right hand/finger.
`LT`	Left side	When the procedure is performed on the left hand/finger.
`22`	Unusual Procedural Services	When work required is substantially greater than typically required for `26433` and well-documented.
`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 extenuating circumstances or patient condition.
`80`	Assistant Surgeon	When an assistant-at-surgery (not a co-surgeon) is required and documented.
`62`	Two Surgeons	When two surgeons of different specialties perform distinct parts of the procedure.
`26`	Professional Component	When reporting only the professional component of a service (rare for this surgical procedure; applicable to components like intraoperative monitoring billed separately).
`TC`	Technical Component	When only the technical component of a service is billed (e.g., facility billing for equipment or imaging tied to the procedure).

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