Radical resection of a soft tissue tumor of the hand or finger measuring less than 3 cm, including wide excision of surrounding tissue margins.

Verified May 8, 2026 · 5 sources ↓

Medicare: $694.40
Work RVU: 9.88
Global, days: 90
Region: Hand

Drawn from CMSAbosCdn-linksAAPCNIH

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Operative note must describe wide en bloc excision with a margin of surrounding normal tissue — not simple tumor removal
Tumor size including excised margins must be documented as less than 3 cm; pathology report should confirm
Pre-operative imaging (MRI or CT) supporting diagnosis of suspected malignancy or aggressive neoplasm
Tissue sent for pathological examination with margin status reported
Anatomic location specified as hand or finger (not forearm or wrist, which map to 25077/25078)
Diagnosis code supporting malignant or aggressive soft tissue neoplasm (e.g., sarcoma) to justify radical vs. simple excision

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 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 5 cited references ↓

CPT 26117 covers radical resection of a soft tissue tumor — typically a malignant neoplasm such as a sarcoma — located in the hand or finger, where the tumor and its excised margins measure less than 3 cm in total. Unlike simple or subcutaneous excision codes (26115, 26116), radical resection requires wide en bloc removal of the tumor with a cuff of normal surrounding tissue, aimed at eliminating all abnormal cells and reducing recurrence risk. The procedure is performed under regional or general anesthesia in a hospital or ASC setting, and the specimen is sent for pathological examination to confirm margin status.

Size thresholds are the primary code-selection driver in this family. If the tumor plus margins reach 3 cm or greater, bill 26118 instead. For non-radical, subfascial excisions under 1.5 cm, 26116 applies; subcutaneous lesions under 1.5 cm use 26115. Misclassifying radical vs. simple excision is the most common audit flag in this code family — the operative note must explicitly support wide-margin resection, not just tumor removal.

The 90-day global period applies. Pre-op imaging (MRI or CT), the surgical encounter, and all routine post-op hand/finger visits through day 90 are bundled. Unrelated problems billed in the global window need modifier 24. Staged or planned re-excision for positive margins billed within the global uses modifier 58.

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 (9.88) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (20.79) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	9.88
Practice expense RVU	8.93
Malpractice RVU	1.98
Total RVU	20.79
Medicare national rate	$694.40
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	$694.40
HOPD (APC 5073) Hospital outpatient department	$2,967.63
ASC (PI G2) Ambulatory surgical center (freestanding)	$1,248.36

Common denial reasons

The recurring reasons claims for CPT 26117 get rejected.

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

Operative note describes simple excision without wide margins — payer downcodes to 26115 or 26116
Tumor size at or above 3 cm without switching to 26118, triggering a mismatch between documentation and billed code
Anatomic site ambiguity — notes referencing wrist or forearm rather than hand or finger cause site-of-service mismatches
Missing or delayed pathology report when payer requires histologic confirmation of malignant diagnosis
Routine post-op visit billed separately within the 90-day global without modifier 24 on an unrelated claim

Frequently asked questions

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

01What's the difference between 26117 and 26116?

26116 is subfascial (intramuscular) excision of a tumor under 1.5 cm — no wide margins required. 26117 is radical resection with en bloc removal of surrounding normal tissue for a suspected malignancy, size under 3 cm. The distinction is surgical intent and technique, not just depth.

02When should I use 26118 instead of 26117?

Use 26118 when the tumor plus its excised margins measure 3 cm or greater. Measure the total resected specimen, not just the tumor itself. If the specimen crosses the 3 cm threshold, 26118 is the correct code regardless of the tumor's pre-op imaging size.

03Can 26117 be billed bilaterally?

Yes, if radical resection is performed on both hands or fingers in the same session, append modifier 50 and bill on a single line. Some payers require separate line items with LT and RT instead — verify payer preference before submitting.

04What global period applies, and what does it include?

26117 carries a 90-day global period. That covers the surgery, the day-before pre-op visit, and all routine post-op hand and finger follow-up through day 90. Re-excision for positive margins within that window is a planned staged procedure — bill with modifier 58.

05Is a malignant diagnosis required to bill 26117?

The code is specifically used for suspected malignant or aggressive tumors (e.g., sarcoma). The diagnosis code should reflect malignant or uncertain behavior of soft tissue. Billing 26117 for a confirmed benign lesion without documentation supporting aggressive behavior invites medical necessity denial.

06How does 26117 relate to squamous cell carcinoma of the finger?

Simple excision of malignant skin lesions maps to the 11600–11646 series. 26117 applies when the surgeon performs a radical resection — wide en bloc removal into deeper soft tissue. The operative note language and depth of resection determine which family is correct, not the diagnosis alone.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the tumor's anatomic location (hand vs. finger, specific digit), the surgical approach including description of wide en bloc resection with normal tissue margins, the measured specimen size, and confirmation that tissue was sent for pathology. This prevents the most common downcode trigger: an operative note that reads as simple excision rather than radical resection with margins, which auditors use to remap the claim to 26115 or 26116.

See how Mira captures CPT 26117 documentation