Surgical removal of a subcutaneous tumor or vascular malformation from the soft tissue of the hand or finger, with the excised lesion measuring less than 1.5 cm.

Verified May 8, 2026 · 5 sources ↓

Medicare: $588.19
Total RVUs: 17.61
Global, days: 90
Region: Hand

Drawn from CMSNIHAAPCCdn-linksEatonhand

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Lesion size documented in centimeters — must be less than 1.5 cm to support 26115 over 26116
Exact anatomic location: specify which hand, which finger, and whether lesion is subcutaneous (not subfascial)
Operative note describes dissection layer — confirms subcutaneous depth, not deep to fascia
Pathology report or operative description identifying lesion type (tumor, vascular malformation, cyst, etc.)
For multiple lesions: separate documentation of size and location for each lesion billed
Medical necessity documentation: clinical indication, symptoms, prior conservative treatment if applicable

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 58 Staged or related 59 Distinct service 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 5 cited references ↓

CPT 26115 covers open excision of a subcutaneous tumor or vascular malformation in the hand or finger when the lesion is under 1.5 cm. The procedure targets benign soft-tissue growths — ganglion cysts, lipomas, vascular malformations, Dupuytren nodules — located above the deep fascia. The size threshold is critical: once the lesion reaches 1.5 cm or crosses into deep soft tissue, you're in 26116 territory.

The 90-day global period means all routine follow-up through day 90 is bundled. Any new problem visit during that window needs modifier 24; a separately documented E/M on the day of surgery needs modifier 25. Multiple lesions excised in the same session on different digits or distinct anatomic sites can each be reported, but append modifier 59 to subsequent lines and document each lesion's size, location, and pathology separately.

Site of service matters here. The HOPD and ASC payment differentials are significant — see the Site of Service comparison on this page. Coding the wrong place of service is a straightforward audit flag. Laterality modifiers (LT/RT) and digit-level modifiers are payer-specific; confirm requirements before submitting, especially for commercial and workers' comp payers.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	3.86
Practice expense RVU	13
Malpractice RVU	0.75
Total RVU	17.61
Medicare national rate	$588.19
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	$588.19
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 26115 get rejected.

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

Missing lesion size measurement — payer cannot confirm the under-1.5 cm threshold for 26115 vs. 26116
Operative note describes 'deep' or subfascial dissection, triggering a downcode or denial in favor of 26116
Multiple units billed without modifier 59 on subsequent lines, causing NCCI bundling edits to fire
Global period violation — E/M or follow-up visit billed within 90 days without modifier 24 or 25
Pathology not submitted or not matching the billed lesion type, raising medical necessity questions

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01What separates 26115 from 26116?

Depth, not just size. 26115 is subcutaneous (above the deep fascia), any size under 1.5 cm. 26116 is deep to fascia, also under 1.5 cm. If your operative note describes subfascial dissection, 26115 is the wrong code regardless of lesion size.

02Can I bill 26115 multiple times in one session for multiple lesions?

Yes, if each lesion is under 1.5 cm, subcutaneous, and in a distinct anatomic location. Append modifier 59 to the second and subsequent lines. Document size and location individually for each lesion — one vague operative note covering all lesions will not hold up to audit.

03Does 26115 have a global period, and what does that mean for post-op visits?

Yes — 90-day global. Routine post-op visits, dressing changes, and suture removal through day 90 are bundled. To bill a same-day E/M, append modifier 25 and document a separately identifiable problem. For unrelated E/M visits during the global, use modifier 24.

04Which laterality and digit modifiers are required?

LT and RT are standard for Medicare when both hands are involved. Digit-level modifiers (FA, F1–F9) are payer-specific — some commercial payers and workers' comp carriers require them; Medicare does not mandate them for hand codes. Confirm with each payer before submitting.

05Can 26115 be billed with a trigger finger release (26055) on the same day?

Only if the excision and the trigger finger release are performed on distinct anatomic structures. Append modifier 59 to the secondary procedure and document each procedure in its own operative note section. Some payers apply MPPR to the second procedure — check your contracts.

06Is a pathology report required for billing 26115?

CMS does not mandate a pathology report as a billing condition, but submitting a specimen for pathology is standard of care and strongly supports medical necessity. A missing or inconsistent pathology report is a frequent audit finding on soft-tissue excision claims.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures lesion size in centimeters, anatomic depth (subcutaneous vs. subfascial), and exact finger/hand location directly from dictation — the three data points auditors check first on 26115 claims. It also flags when the surgeon describes deep dissection, prompting a review of 26116 before the claim goes out.

See how Mira captures CPT 26115 documentation