Surgical incision of a finger tendon sheath to release constriction, most commonly performed for trigger finger (stenosing tenosynovitis).

Verified May 8, 2026 · 6 sources ↓

Medicare: $629.61
Total RVUs: 18.85
Global, days: 90
Region: Hand

Drawn from CMSAAPCPacificsourceMedicare.gov

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Identify the specific digit(s) by name and number (e.g., right long finger, digit 3) — vague references to 'the affected finger' are insufficient for digit-modifier billing.
Confirm the diagnosis driving the procedure (stenosing tenosynovitis, trigger finger) with severity description — locked, grade, failed conservative treatment.
Document failed non-surgical management (corticosteroid injection, splinting) if required by payer for medical necessity, particularly for Medicaid plans requiring prior authorization.
Operative note must name the anatomic structure incised (A1 pulley / tendon sheath) and confirm tendon gliding was verified after release.
Record anesthesia type — local block administered intraoperatively is not separately billable and should not appear as a standalone line item.
For multi-digit cases, document each finger independently with its own incision, technique confirmation, and intraoperative finding.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 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

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 26055 covers open tendon sheath incision of the finger — the standard surgical approach for trigger finger release. The surgeon makes a small incision at the base of the affected finger on the palm, then cuts the A1 pulley (tendon sheath) to eliminate the constriction causing the finger to lock or catch. Local anesthesia is typical; the procedure is almost always done in an outpatient or ASC setting. Hand surgeons, orthopedic surgeons, and plastic/reconstructive surgeons are the top billing specialties per CMS PUF data.

The code carries a 90-day global period. All routine follow-up visits, dressing changes, and suture removal through day 90 are bundled. Any unrelated E/M or procedure in that window needs modifier 24 or 79, respectively. When the same release is performed on multiple fingers in one session, use digit modifiers (FA, F1–F9) per NCCI guidance — MUE values for finger procedures are frequently set to one per digit, so proper modifier use is what allows multi-finger billing to clear.

When billing 26055 alongside carpal tunnel release (64721) or another hand procedure on the same date, NCCI does not bundle these codes, so modifier 51 applies to the secondary procedure — not 59. Local anesthetic injection administered as part of the surgical approach is not separately reportable; billing a nerve block or tendon sheath injection code alongside 26055 for the anesthesia component is a known audit trigger.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	3.03
Practice expense RVU	15.24
Malpractice RVU	0.58
Total RVU	18.85
Medicare national rate	$629.61
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	$629.61
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 26055 get rejected.

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

Missing digit modifier (FA, F1–F9) when billing multiple trigger finger releases in a single session, causing MUE violations.
Separate billing of local anesthetic injection (e.g., 20550, 64450) as a distinct service when it was used solely for surgical anesthesia — bundled per NCCI policy.
Lack of prior authorization for Medicaid/OHP patients — PacificSource and other state Medicaid plans have required PA for 26055 since November 2023.
Modifier 51 missing or wrong modifier used when 26055 is billed same-day with carpal tunnel release (64721) or another hand procedure; some coders incorrectly append 59.
Insufficient medical necessity documentation — payers require evidence of conservative treatment failure before approving open surgical release.

Frequently asked questions

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

01Can I bill 26055 for the thumb?

Yes. The code applies to any finger including the thumb. Use modifier FA for the right thumb or F5 for the left thumb. Document the thumb specifically in the operative note.

02If I release two trigger fingers on the same hand during one session, how do I bill?

Bill 26055 twice, each with the appropriate digit modifier (e.g., F2 and F3). Append modifier 51 to the secondary unit. MUE for this code is set at one per digit, so the digit modifiers are what allow both units to pass.

03Is 26055 billable same-day as carpal tunnel release (64721)?

Yes. NCCI does not bundle 26055 with 64721. Append modifier 51 to 26055 as the secondary procedure. Expect a standard multiple-procedure reduction on the secondary code.

04Can I separately bill a digital nerve block or tendon sheath injection when performed as surgical anesthesia for 26055?

No. Local anesthesia injections performed as part of a surgical approach are not separately reportable per NCCI policy. Billing a separate injection code for the anesthetic is a known audit flag.

05What modifier applies if the patient returns to the OR during the 90-day global for a related complication?

Use modifier 78 for an unplanned return to the OR for a procedure related to the original trigger finger release. Use modifier 79 only if the new procedure is entirely unrelated to the original surgery.

06Do Medicaid plans require prior authorization for 26055?

Some do. PacificSource Medicaid/OHP implemented a PA requirement for 26055 effective November 1, 2023. Check state-specific Medicaid fee schedules and payer portals before scheduling — missing PA on a Medicaid claim for this code will result in a denial regardless of medical necessity documentation.

07What global period applies to 26055, and what does it cover?

26055 carries a 90-day global period. That covers the surgery itself, the day-before pre-op visit, and all routine post-op care through day 90 including dressing changes and suture removal. Bill modifier 24 for an unrelated E/M visit in that window, or modifier 79 for an unrelated surgical procedure.

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 digit treated, the approach (palmar incision at A1 pulley), confirmation of free tendon gliding post-release, and anesthesia type from the surgeon's dictation. It auto-assigns the correct digit modifier (FA, F1–F9) and flags same-session procedures requiring modifier 51 — preventing the two most common denial patterns for this code before the claim is submitted.

See how Mira captures CPT 26055 documentation