Radical resection of a soft tissue tumor of the hand or finger measuring 3 cm or greater, including sarcoma-type resections requiring wide margins.

Verified May 8, 2026 · 5 sources ↓

Medicare: $973.97
Total RVUs: 29.16
Global, days: 90
Region: Hand

Drawn from CMSEmednyCgsmedicare

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Tumor size documented as 3 cm or greater in the operative note and confirmed on final pathology report
Explicit description of radical (wide-margin) resection technique, not simple or marginal excision
Anatomic location specified — identify the affected hand, finger, or ray by name and side (LT/RT)
Tissue margin status noted in operative report (margins clear, close, or positive)
Preoperative imaging (MRI preferred) confirming lesion size and soft tissue involvement
Tumor histology or working diagnosis documented in the preoperative assessment or pathology requisition

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 5 cited references ↓

CPT 26118 covers radical resection of a soft tissue tumor — typically a sarcoma or aggressive benign neoplasm — of the hand or finger when the lesion measures 3 cm or more. Radical resection means wide-margin en bloc removal, not simple excision; the surgeon removes the tumor along with a cuff of surrounding normal tissue to achieve oncologic clearance. This is the larger-lesion counterpart to 26117, which covers tumors under 3 cm.

The 90-day global period applies. All routine postoperative care — wound checks, dressing changes, staple removal — is bundled through day 90. Bill modifier 24 for unrelated E/M visits in that window and modifier 78 for an unplanned return to the OR for a complication directly related to the original resection. An unrelated procedure in the global period takes modifier 79.

Size documentation is the single most common audit trigger for this code. The operative note and pathology report must both corroborate a lesion of 3 cm or greater. If the final pathology measurement falls below 3 cm, the correct code is 26117. Reconstruction performed at the same session — skin grafting, flap coverage — is reported separately when it represents distinct additional work beyond simple closure.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	14.44
Practice expense RVU	11.81
Malpractice RVU	2.91
Total RVU	29.16
Medicare national rate	$973.97
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	$973.97
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 26118 get rejected.

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

Tumor size not documented at or above the 3 cm threshold — payer downcodes to 26117
Operative note describes simple or marginal excision rather than radical resection with wide margins
Missing or discordant pathology report — size on path differs from size documented in the operative note
Laterality missing — LT or RT modifier absent on the claim, triggering edit or return-to-provider
Reconstruction billed without documentation supporting it as a distinct, separately identifiable procedure

Frequently asked questions

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

01What is the size threshold that separates 26118 from 26117?

26117 applies when the tumor is less than 3 cm; 26118 applies when it is 3 cm or greater. Use the final pathology measurement, not the preoperative imaging estimate, if there is a discrepancy.

02Can I bill a skin graft or flap separately on the same day as 26118?

Yes, when reconstruction requires a distinct procedure beyond simple wound closure. Document the reconstructive work separately in the operative note and append modifier 59 or XS to the reconstruction code to establish it as a separate service.

03Does 26118 carry a global period, and what does that include?

26118 has a 90-day global period. Routine post-op visits, dressing changes, and suture or staple removal are all bundled. Unrelated E/M visits in the global window need modifier 24; a related return to the OR takes modifier 78.

04If the same surgeon performs the resection and the reconstruction, do I need modifier 51?

Append modifier 51 to the secondary procedure (the reconstruction) when billing multiple surgical procedures on the same day by the same surgeon to indicate multiple procedures and prevent a misread as duplicate billing.

05What diagnosis codes support 26118?

Malignant soft tissue neoplasms of the hand (ICD-10 C49.1x) and benign neoplasms requiring radical excision (D21.1x) are the primary supporting diagnoses. The specific ICD-10 code should match the pathology-confirmed histology, not just the preoperative working diagnosis.

06Is 26118 payable in an ASC setting?

Yes. CMS has established a separate ASC payment rate for 26118, which differs substantially from the HOPD rate. See the site-of-service comparison table on this page for current 2026 figures.

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 directly from dictation, flags the excision technique as radical versus marginal, and records laterality and finger/ray designation. This prevents the most common downcoding scenario — a claim landing on 26117 because size or technique language was absent from the operative note at the time of submission.

See how Mira captures CPT 26118 documentation