Surgical opening of a finger interphalangeal joint with collection of a synovial tissue sample for pathologic analysis.

Verified May 8, 2026 · 7 sources ↓

Medicare: $317.98
Total RVUs: 9.52
Global, days: 90
Region: Hand

Drawn from CMSAAPCFindacodeMdclarityEatonhand

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Specify which interphalangeal joint was biopsied — PIP or DIP — and which digit (e.g., right long finger PIP joint).
Document clinical indication: why synovial biopsy was necessary and what diagnoses were being evaluated.
Describe the surgical approach by name and confirm arthrotomy was performed with joint capsule entry, not percutaneous needle biopsy.
Confirm synovial tissue was submitted to pathology and note the specimen label used.
Record anesthesia type (local, regional, or general) and tourniquet use if applicable.
If multiple joints were biopsied in the same session, document each joint separately with distinct operative descriptions.

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 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 80 Assistant surgeon LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 26110 describes an arthrotomy of a finger interphalangeal joint — either proximal (PIP) or distal (DIP) — performed specifically to obtain a biopsy of the joint lining (synovium). The surgeon makes a direct incision over the joint, opens the capsule, harvests synovial tissue, and closes in layers. It is coded per joint ('each'), so multiple interphalangeal joints biopsied in the same session require separate line items with appropriate digit modifiers.

The procedure is most commonly indicated when imaging and serology are insufficient to distinguish between inflammatory arthropathy (RA, psoriatic arthritis, crystal disease), septic arthritis, or atypical synovial pathology. The 90-day global period applies, meaning all routine follow-up care through day 90 — including wound checks and suture removal — is bundled. Unrelated E/M services in that window require modifier 24.

Code 26110 sits in the arthrotomy-with-biopsy family alongside 26100 (carpometacarpal joint) and 26105 (metacarpophalangeal joint). Choose based on the specific joint entered, not the digit. Pathology processing of the retrieved specimen is billed separately under the appropriate 88300-series code by the interpreting pathologist.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	3.56
Practice expense RVU	5.28
Malpractice RVU	0.68
Total RVU	9.52
Medicare national rate	$317.98
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	$317.98
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 26110 get rejected.

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

Digit modifier omitted — payers reject claims when the specific finger and laterality are not identified with F-series or LT/RT modifiers.
Biopsy indication not supported — missing clinical documentation showing why less invasive diagnostic methods were inadequate.
Confusion with 26105 (MCP joint) or 26100 (CMC joint) — wrong code selected for the joint actually entered, triggering a mismatch denial.
Bundling with same-day E/M when modifier 25 is absent — evaluation service denied without proof of a separately identifiable, documented decision.
Prior authorization not obtained — some commercial payers and Medicaid managed care plans require PA for any finger joint arthrotomy.

Frequently asked questions

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

01Is 26110 coded per joint or per digit?

Per joint. If you biopsy the PIP and DIP of the same finger, bill 26110 twice with modifier 59 (or XS) to distinguish the separate structures. Use digit-level F-series modifiers to identify each.

02Which modifier identifies the specific finger for 26110?

Use the HCPCS Level II F-series modifiers (F1–F9, FA) to identify the exact digit and hand. LT/RT alone is insufficient for finger-level specificity and will cause denials on claims requiring digit identification.

03Can 26110 and 26105 be billed together on the same date?

Yes, if both a metacarpophalangeal joint and an interphalangeal joint of different fingers were biopsied in the same session. Bill each code with the appropriate digit modifier and modifier 51 on the lower-value code. Document each arthrotomy separately in the operative note.

04Is the pathology reading bundled into 26110?

No. The surgical collection is captured by 26110. The pathologist bills separately under the 88300 series for specimen processing and interpretation. Both can be billed on the same date without a bundling conflict.

05What is the global period for 26110 and what does it cover?

26110 carries a 90-day global period. That includes the day-before preoperative visit, the surgery itself, and all routine post-op care through day 90 — wound checks, suture removal, and dressing changes. Use modifier 24 for unrelated E/M visits and modifier 79 for unrelated surgical procedures within that window.

06When is modifier 22 appropriate for 26110?

Use modifier 22 when operative complexity is substantially above typical — for example, severe fibrosis or ankylosis requiring significantly extended joint dissection. You must attach a cover letter explaining the added work; without it, most payers ignore the modifier and pay at the standard rate.

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 joint level (PIP vs. DIP), digit number, laterality, and the clinical rationale for proceeding to open biopsy rather than aspiration or needle sampling. It also flags whether the joint capsule was formally entered and documents specimen submission to pathology. This prevents the two most common denial triggers: missing digit/laterality identifiers and insufficient medical necessity documentation for an open arthrotomy approach.

See how Mira captures CPT 26110 documentation