Surgical drainage of a complicated deep finger abscess, such as a felon (pulp space infection of the fingertip).

Verified May 8, 2026 · 7 sources ↓

Medicare: $517.05
Work RVU: 2.18
Global, days: 10
Region: Hand

Drawn from CMSMdclarityAAPCNethealth

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 7 cited references ↓

Specify the finger involved and laterality (e.g., left index finger) in the operative note
Document that the abscess involved a deep compartment or pulp space — not a superficial subcutaneous collection — to justify 26011 over 26010 or 10060
Name the type of abscess (e.g., felon, web space abscess) and describe the surgical approach used to access it
Record wound packing, irrigation, culture specimens obtained, and post-procedure condition of the wound
Include a valid ICD-10-CM diagnosis code (e.g., L02.51x for finger abscess) — claims submitted without one are returned as incomplete under SSA §1833(e)
If billing more than two drainage procedures on the same site within 12 months, document clinical rationale for why definitive treatment is not appropriate

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

25 Significant separate E/M 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 58 Staged or related 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 26011 covers incision and drainage of a complicated finger abscess — the classic example being a felon, a closed-space infection of the fingertip pulp. This is the higher-complexity counterpart to 26010 (simple drainage). Use 26011 when the abscess involves a deep compartment of the finger requiring more extensive surgical release, not a superficial subcutaneous collection. If the operative note doesn't distinguish depth and complexity, payers will default to the lower-paying 26010 or generic skin I&D codes like 10060.

The global period is 10 days. Wound checks and routine post-op visits within that window are bundled — bill them separately only with modifier 24 if the visit addresses a completely unrelated problem. Repeat drainage within the global period by the same surgeon requires modifier 58. Anesthesia administered by the operating physician is included in the procedure's reimbursement and is not separately payable.

CMS LCD guidance is explicit: finger abscesses should be coded with 26010–26011, not generic skin I&D codes. More than two drainage procedures on the same anatomical site in a 12-month period will face medical necessity scrutiny. Documentation must clearly justify why definitive treatment (e.g., more extensive surgery, IV antibiotics, infectious disease consult) was not pursued.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU vs. total RVU

The work RVU (2.18) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (15.48) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	2.18
Practice expense RVU	12.87
Malpractice RVU	0.43
Total RVU	15.48
Medicare national rate	$517.05
Global period	10 days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

Setting	Medicare rate (national)
Office (PFS non-facility) Procedure performed in physician's office	$517.05
HOPD (APC 5072) Hospital outpatient department	$1,687.37
ASC (PI A2) Ambulatory surgical center (freestanding)	$742.04

Common denial reasons

The recurring reasons claims for CPT 26011 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Downcoded to 26010 or 10060 because the operative note fails to document depth or compartment involvement distinguishing a complicated abscess
Claim returned as incomplete due to missing or invalid ICD-10-CM diagnosis code
Repeat drainage within the 10-day global period billed without modifier 58, triggering a duplicate claim denial
Anesthesia billed separately by the operating physician — it is included in the procedure's reimbursement and is not separately payable
Medical necessity denial for more than two drainage procedures on the same site in 12 months without documented justification for why definitive therapy is not appropriate

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01What distinguishes 26011 from 26010?

26010 is for a simple finger abscess; 26011 is for a complicated one — the prototypical example being a felon, which involves the closed pulp space of the fingertip. The surgical release for a felon is more extensive than a superficial incision. If the note doesn't document depth or compartment involvement, payers will downcode to 26010.

02Can I bill 26011 instead of 10060 for a finger abscess?

Yes — and CMS LCD guidance says you should. Finger abscesses have anatomically specific codes (26010–26011), and payers expect you to use them rather than the generic skin I&D code 10060. Using 10060 for a finger abscess risks denial or audit flags for miscoding.

03The surgeon drained the same finger abscess again 5 days later. How do I bill the repeat procedure?

The global period for 26011 is 10 days. Repeat drainage by the same surgeon within that window requires modifier 58 (staged or related procedure during the postoperative period). Without modifier 58, the claim will deny as a duplicate or global-period bundling issue.

04Can I bill an E/M visit on the same day as 26011?

Yes, but only if the E/M documents a separately identifiable service beyond the decision to perform the I&D. Append modifier 25 to the E/M code. Without modifier 25, the E/M will be bundled into the procedure payment.

05Is 26011 bilateral-eligible, and how do I bill it?

If abscesses on fingers of both hands are drained in the same session, append modifier 50 for bilateral procedures. Alternatively, bill once with LT and once with RT, depending on your payer's preference. Confirm which format your specific payer requires before submitting.

06What happens if the patient needs more than two finger abscess drainages in the same year?

CMS considers more than two drainage procedures on the same anatomical site within 12 months to be uncommon and will scrutinize those claims for medical necessity. Documentation must clearly explain why definitive treatment — such as surgical excision, IV antibiotics, or specialist referral — was not appropriate.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira Scribe

Mira's AI scribe captures the abscess location (specific finger, pulp space vs. superficial), depth of involvement, surgical approach and release technique, irrigation and packing details, and any cultures obtained. This prevents downcoding to 26010 or 10060 by audit teams flagging operative notes that lack compartment-level detail — the single most common reason 26011 claims are reduced at adjudication.

See how Mira captures CPT 26011 documentation