Open palmar fasciotomy releasing a Dupuytren's contracture through incision of the palmar fascia, without fascia excision.

Verified May 8, 2026 · 6 sources ↓

Medicare: $308.62
Total RVUs: 9.24
Global, days: 90
Region: Hand

Drawn from CMSCgsmedicareAAPCEatonhand

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Confirm diagnosis of palmar fascia contracture with specific digit(s) affected and degree of flexion contracture measured in degrees
Operative note must name the procedure as fasciotomy (incision/division) — not fasciectomy — to defend 26040 over 26045
Document the surgical approach and which palmar cord(s) were incised by location (e.g., pretendinous cord to ring finger)
Record intraoperative assessment of neurovascular structure identification and protection
Note whether the procedure was unilateral or bilateral, and document the specific hand (right or left) for laterality modifiers
For modifier 22, document specific factors that increased operative complexity — dense fibrosis, neurovascular displacement, prior surgery

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 24 Unrelated E/M during global 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 6 cited references ↓

CPT 26040 covers an open incisional release of the palmar fascia to correct a contracture — most commonly Dupuytren's disease. The surgeon incises the diseased cord under direct visualization to restore finger extension. This is a fasciotomy (division only), not a fasciectomy (excision); selecting the wrong code between 26040 and 26045 is one of the most common audit triggers in hand surgery billing.

The 90-day global period means the surgery, the day-before visit, and all routine postoperative care through day 90 are bundled. Bill unrelated E/M visits in the global window with modifier 24. If the patient returns to the OR for a related complication — say, a wound dehiscence requiring irrigation — use modifier 78. An unrelated procedure in the same global window gets modifier 79.

Place of service matters here. Medicare has denied 26040 billed at POS 11 (office) on the grounds that the procedure is inconsistent with an office setting. Verify your MAC's coverage policy before scheduling this in the office. ASC and HOPD are the safest settings for Medicare patients.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	3.37
Practice expense RVU	5.25
Malpractice RVU	0.62
Total RVU	9.24
Medicare national rate	$308.62
Global period	90 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	$308.62
HOPD (APC 5112) Hospital outpatient department	$1,642.82
ASC (PI A2) Ambulatory surgical center (freestanding)	$872.87

Common denial reasons

The recurring reasons claims for CPT 26040 get rejected.

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

Place of service mismatch: Medicare denies 26040 billed at POS 11 (office) as inconsistent with the procedure's expected setting
Code confusion between 26040 (fasciotomy) and 26045 (open partial fasciectomy) — downcoded or denied when the op note describes tissue excision rather than division only
Missing or ambiguous laterality: claims without LT or RT modifier flagged by payers requiring side designation for hand procedures
Unbundling denials when 26040 is billed same-day with component incision codes that are already included in the palmar release
Lack of medical necessity documentation — no recorded contracture severity, failed conservative management history, or functional limitation

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01What is the difference between CPT 26040 and CPT 26045?

26040 is a fasciotomy — the palmar cord is incised and divided but not removed. 26045 is an open partial fasciectomy — diseased fascia is excised. The operative note must clearly describe what the surgeon did; 'cord release' without more detail invites downcoding or audit.

02Can 26040 be billed in an office setting under Medicare?

Medicare has denied 26040 at POS 11 as inconsistent with the office setting. Verify your MAC's policy before booking this in the office. ASC (POS 24) and HOPD (POS 22) are consistently accepted.

03How do you bill 26040 when both hands are treated in the same session?

Append modifier 50 for a bilateral procedure, or bill two line items with LT and RT. Confirm payer preference — some commercial payers require the two-line approach rather than modifier 50.

04What is the global period for 26040 and what does it include?

26040 carries a 90-day global. That covers the surgery, the day-before visit, and all routine postoperative care through day 90. E/M visits for unrelated problems in that window need modifier 24; a new, unrelated procedure needs modifier 79.

05When is modifier 22 appropriate for 26040?

Use modifier 22 when operative complexity substantially exceeded the typical case — for example, dense fibrosis with neurovascular displacement, revision after prior surgery, or prolonged dissection. The operative note must detail the specific factors; modifier 22 without supporting documentation will be stripped on audit.

06Is modifier 78 or 79 correct when the patient returns to the OR during the global period?

Modifier 78 applies to an unplanned return for a procedure related to the original surgery — such as wound complications from the palmar release. Modifier 79 applies to a procedure that is unrelated to the original surgery. Do not invert these.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures the specific cord(s) released by name and location, the degree of flexion contracture corrected, digit(s) involved, laterality, and the surgeon's confirmation that the procedure was fasciotomy (division) rather than fasciectomy. That documentation locks in 26040 over 26045 and supplies the medical necessity detail — measured contracture, functional deficit — that prevents medical necessity denials and supports modifier 22 if complexity was elevated.

See how Mira captures CPT 26040 documentation