Surgical removal of a subfascial (intramuscular) tumor or vascular malformation from the hand or finger, with the excised lesion measuring less than 1.5 cm.

Verified May 8, 2026 · 6 sources ↓

Medicare: $494.00
Work RVU: 6.57
Global, days: 90
Region: Hand

Drawn from AAPCAbosJohnericksonmdMdclarityFindacode

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Operative note must confirm subfascial (intramuscular) depth — not simply 'deep' without anatomic specificity
Lesion size in centimeters must be documented, ideally measured at the time of excision and confirmed by pathology
Pathology report should be linked to the operative note to support diagnosis and rule out malignancy requiring escalation to 26117/26118
Document which hand and which digit or region of the hand (supports LT/RT modifier assignment)
Indications for surgery should be explicit — pain, functional limitation, suspicion of malignancy, or failed conservative management
Describe the surgical approach and neurovascular structures encountered or protected during subfascial dissection

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 58 Staged or related 59 Distinct service 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 6 cited references ↓

CPT 26116 covers excision of a deep soft tissue tumor or vascular malformation located beneath the fascia of the hand or finger — intramuscular territory — when the lesion is smaller than 1.5 cm. The subfascial depth is what separates 26116 from its subcutaneous counterpart, 26115. Getting below the fascia requires more dissection, more careful neurovascular protection, and carries greater operative complexity, which is reflected in its higher RVU weight.

The code family context matters for accurate selection. Use 26115 for subcutaneous lesions under 1.5 cm, 26111 for subcutaneous lesions 1.5 cm or greater, 26113 for subfascial lesions 1.5 cm or greater, and 26117/26118 for radical resections (e.g., sarcoma). If the operative note documents tumor size at or above 1.5 cm, step up to 26113 — size thresholds are a frequent audit trigger.

The 90-day global period applies. All routine post-op management, wound checks, and suture removal through day 90 are bundled. Unrelated procedures during that window need modifier 79. If pathology comes back malignant and a re-excision is planned, that's a new decision — document accordingly and consider modifier 58 if staged or modifier 78 if the return is unplanned and related.

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 (6.57) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (14.79) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	6.57
Practice expense RVU	6.97
Malpractice RVU	1.25
Total RVU	14.79
Medicare national rate	$494.00
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	$494.00
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 26116 get rejected.

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

Code billed as 26116 but operative note describes a subcutaneous lesion — should be 26115; depth mismatch triggers downcoding
Lesion size at or above 1.5 cm documented in the note or pathology report without stepping up to 26113
Missing LT or RT modifier when payer policy requires laterality for hand procedures
Bundling denials when 26116 is billed same-day with evaluation and management without modifier 25 on the E/M
Insufficient documentation of subfascial depth — operative notes stating only 'deep excision' without naming anatomic layer

Frequently asked questions

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

01What separates 26116 from 26115?

Depth. Both cover lesions under 1.5 cm in the hand or finger. 26115 is subcutaneous — above the fascia. 26116 is subfascial, meaning intramuscular. The operative note must confirm the surgeon dissected below the fascial layer to support 26116.

02When should I use 26113 instead of 26116?

When the subfascial lesion is 1.5 cm or greater. If the excised specimen measures 1.5 cm or more — per the operative note or pathology report — 26113 is the correct code. Billing 26116 with documented size at threshold is a common audit flag.

03Does 26116 require laterality modifiers?

Most payers require LT or RT for hand procedures. Apply LT for left hand/finger, RT for right. If both hands are operated on in the same session, use modifier 50 and verify payer-specific bilateral payment rules.

04Can I bill an E/M on the same day as 26116?

Yes, if a separately identifiable evaluation and management service was performed. Append modifier 25 to the E/M. Without it, the E/M will bundle into the procedure and deny.

05What modifier applies if pathology returns malignant and re-excision is needed within the global period?

Modifier 58 if the re-excision was staged or planned (e.g., awaiting margins). Modifier 78 if the patient returned unplanned for a related complication or inadequate margins requiring immediate operative management. Do not use 79 — that is for unrelated procedures.

06Is 26116 appropriate for a glomus tumor excision in the finger?

Yes, if the glomus tumor is confirmed subfascial and under 1.5 cm. Glomus tumors are a common use case. Document the subungual or intramuscular location explicitly in the operative note to withstand payer review.

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 confirmation, measured lesion size, digit or hand region, and neurovascular structures encountered during dissection — directly from surgeon dictation. That prevents the two most common 26116 denials: a subcutaneous depth description that forces a downcode to 26115, and a missing or inconsistent lesion size that auditors use to challenge the code selection.

See how Mira captures CPT 26116 documentation