Open partial fasciotomy of the palm — the surgeon incises (but does not excise) the thickened palmar fascia to release the contracture, preserving the fibrous tissue in place.

Verified May 8, 2026 · 7 sources ↓

Medicare: $453.25
Total RVUs: 13.57
Global, days: 90
Region: Hand

Drawn from CMSNimblercmMdclarityGenhealthEatonhand

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Specify surgical approach explicitly as 'open' — a note that says only 'fasciotomy' is insufficient to defend 26045 over 26040
Document that fascia was incised, not excised — excision shifts the code family to 26123/26125
Identify the affected digit(s) and extent of contracture correction achieved intraoperatively
Record which hand (left or right) was treated to support LT/RT modifier assignment
Note neurovascular structures identified and protected during the dissection
Include pre-operative MCP and PIP joint extension deficit measurements to establish medical necessity

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 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 26045 describes an open, partial fasciotomy of the palm performed to release a flexion contracture — most commonly Dupuytren's contracture. The surgeon makes a palmar incision, identifies the diseased fascia, and divides it to relieve the mechanical restriction on finger extension. Unlike fasciectomy codes (26123, 26125), no tissue is removed; the fascia is cut, not excised. The distinction matters for code selection and audit defense.

The open approach under 26045 contrasts directly with 26040, which covers the percutaneous technique (including needle aponeurotomy). If the surgeon documents a percutaneous approach, 26040 applies regardless of how extensive the release was. If the operative note lacks a clear description of the surgical approach, coders default to querying the surgeon — not guessing.

The 90-day global period means all routine postoperative hand therapy evaluations, suture removals, and wound checks by the operating surgeon are bundled through day 90. New problems or unrelated procedures in that window require modifier 24 or 79, respectively. Bilateral release at the same session bills with modifier 50 on a single line.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	5.59
Practice expense RVU	6.87
Malpractice RVU	1.11
Total RVU	13.57
Medicare national rate	$453.25
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	$453.25
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI A2) Ambulatory surgical center (freestanding)	$1,644.87

Common denial reasons

The recurring reasons claims for CPT 26045 get rejected.

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

Operative note documents a percutaneous or needle technique, making 26040 the correct code instead of 26045
Fascia described as excised or removed — auditors recode to 26123/26125 fasciectomy family
Bilateral procedure billed as two line items without modifier 50, triggering duplicate-service edit
Lack of documented MCP/PIP contracture severity to meet payer-specific medical necessity thresholds
Post-op E/M billed within the 90-day global period without modifier 24 to indicate an unrelated visit

Frequently asked questions

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

01What is the difference between 26045 and 26040?

26040 is the percutaneous approach — needle aponeurotomy falls here. 26045 requires an open incision into the palm. If the operative note describes multiple needle sticks without a formal incision, 26040 applies even if the release was extensive.

02When does Dupuytren's release shift from 26045 to the fasciectomy codes?

Once the surgeon removes palmar fascia rather than simply dividing it, you're in the fasciectomy family: 26123 for partial palmar fasciectomy without digit involvement, with 26125 added per additional digit released. Document 'excision' vs. 'incision' precisely — that single word drives the code selection.

03Can 26045 be billed bilaterally?

Yes. If both palms are released in the same operative session, bill 26045 with modifier 50 on one line. Some payers require two lines with LT and RT instead — verify payer preference before submitting.

04How is the 90-day global period managed for postoperative hand therapy?

Routine post-op visits by the operating surgeon are bundled through day 90. Occupational or physical therapy billed by a separate therapist is not subject to the surgical global and bills independently. If the surgeon personally bills an E/M for an unrelated condition during the global, append modifier 24 with a supporting diagnosis unrelated to the contracture.

05Does modifier 22 apply when the contracture is severe or recurrent?

Modifier 22 is defensible when documentation supports substantially increased operative time or complexity — for example, dense scarring from a prior fasciectomy, prior skin grafting, or neurovascular involvement requiring extended dissection. Attach an operative note summary letter and expect a payer audit; modifier 22 without supporting documentation is routinely ignored or denied.

06Is 26045 appropriate in an ASC setting?

Yes. 26045 is commonly performed in ambulatory surgery centers. See the Site of Service comparison on this page for the current ASC and HOPD payment differentials under CMS Physician Fee Schedule 2026.

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 surgical approach (open vs. percutaneous), the specific palmar fascia divided, digit(s) involved, pre- and post-release extension angles, and neurovascular structure identification from the surgeon's dictation. This prevents the most common audit flag for 26045: an operative note that fails to distinguish open fasciotomy from percutaneous technique, which auditors use to recode to 26040 or deny entirely.

See how Mira captures CPT 26045 documentation