Subfascial excision of a tumor or vascular malformation of the hand or finger measuring 1.5 cm or greater, requiring dissection below the fascial layer into deep soft tissue or muscle.

Verified May 8, 2026 · 6 sources ↓

Medicare: $512.04
Work RVU: 6.95
Global, days: 90
Region: Hand

Drawn from MdclarityAAPCEmednyCMSCgsmedicare

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Confirm subfascial depth explicitly — document that dissection extended below the fascial layer, not just into subcutaneous tissue
Record the exact measured size of the excised specimen (1.5 cm or greater required for 26113 over 26116)
Specify laterality (left or right hand or finger) and the specific digit or anatomical location within the hand
Document the nature of the lesion — tumor, ganglion, vascular malformation, or other — and include pathology report correlation
Describe the surgical approach and technique, including how muscle or fascial planes were managed and whether neurovascular structures were preserved
Note the indication: pain, functional impairment, suspected malignancy, or growth characteristics driving surgical decision

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 59 Distinct service 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side XS Separate structure 80 Assistant surgeon AS PA/NP/CNS assistant

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 26113 covers surgical removal of a subfascial (e.g., intramuscular) tumor or vascular malformation from the hand or finger when the lesion measures 1.5 cm or more. The subfascial depth distinguishes this code from its subcutaneous counterpart (26111) — the dissection must go below the fascia, often into muscle planes, to reach the pathology. Smaller deep lesions under 1.5 cm are reported with 26116.

The 90-day global period applies. That means all routine post-op visits, wound care, and stitch removal through day 90 are bundled. Complications requiring a return to the OR for a related issue during that window need modifier 78. An unrelated procedure in the same global period requires modifier 79. Laterality modifiers (LT/RT) are expected on every claim — omitting them is a common reason for rejection.

Tumors that prove to be malignant on pathology may warrant separate coding for radical resection (26117/26118), which carries different documentation and margin-reporting obligations. If pathology results change the clinical picture post-operatively, ensure the operative note and diagnosis codes reflect what was actually found, not just what was suspected preoperatively.

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 (6.95) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (15.33) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	6.95
Practice expense RVU	7.07
Malpractice RVU	1.31
Total RVU	15.33
Medicare national rate	$512.04
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	$512.04
HOPD (APC 5072) Hospital outpatient department	$1,687.37
ASC (PI G2) Ambulatory surgical center (freestanding)	$742.04

Common denial reasons

The recurring reasons claims for CPT 26113 get rejected.

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

Missing laterality modifier (LT or RT) — most payers require it for hand and finger procedures
Depth not documented: claims denied or down-coded to subcutaneous code 26111 when operative note fails to confirm subfascial dissection
Lesion size not documented or ambiguous — if the operative or pathology report doesn't confirm ≥1.5 cm, payers will down-code to 26116
Unbundling conflicts when wound closure or neurolysis codes are billed separately without modifier 59 or XS support
ICD-10 diagnosis code mismatch — using a benign neoplasm code when pathology returns malignancy, or vice versa, triggers post-payment audits

Frequently asked questions

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

01What separates 26113 from 26111?

Tissue depth. 26111 is subcutaneous (above the fascia); 26113 requires the tumor to be subfascial — below the fascial layer, often within or adjacent to muscle. Both require ≥1.5 cm. If you can't document that you went below the fascia, 26111 is the correct code.

02When do I use 26116 instead of 26113?

26116 is the subfascial code for lesions under 1.5 cm. Same depth requirement as 26113, but the size threshold differentiates them. Use the pathology report measurement, not the pre-op imaging estimate, to confirm code selection.

03Is a bilateral hand procedure billed with modifier 50 or two line items?

Bilateral hand procedures are rare for a single tumor excision, but if both hands are operated on in the same session, bill the second side with LT/RT on separate line items rather than modifier 50 alone — many payers prefer distinct lines for hand surgery laterality. Confirm with the specific payer's billing policy.

04Does the 90-day global period include physical therapy referrals?

No. PT services are billed by the treating therapist under their own codes and are not bundled into the surgical global. The 90-day global only bundles the operating surgeon's own post-op visits and minor related services.

05Can I bill a separate E/M on the day of surgery?

Only if the decision for surgery was made at that same visit and the E/M was a significant, separately identifiable service. That requires modifier 57. If the decision for surgery was already made at a prior visit, a same-day E/M by the same surgeon is bundled.

06What if pathology returns malignancy after a 26113 excision?

If margins are involved and re-excision is required, that return to the OR during the global period for a related procedure uses modifier 78. If the pathology finding prompts a planned radical resection (26117/26118), that is a distinct procedure requiring careful documentation of what was performed and why it exceeds the original excision in scope.

07Is 26113 subject to NCCI bundling with closure codes?

Simple wound closure is generally considered integral to excision procedures and not separately billable. Complex closure or layered repair may be separately reportable with modifier 59 or XS if clearly documented as distinct work beyond routine closure. Check the NCCI PTP edits for specific code pairs before billing.

Sources & references

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

Mira Scribe

Mira's AI scribe captures subfascial depth, exact specimen measurement, digit or hand location, laterality, and the surgeon's description of fascial and muscle plane management directly from dictation. That documentation trio — depth, size, and side — prevents the three most common down-code and denial scenarios for 26113: subcutaneous reclassification to 26111, size-based down-coding to 26116, and laterality rejections.

See how Mira captures CPT 26113 documentation