Partial palmar fasciectomy with release of a single digit, including the proximal interphalangeal joint, performed with or without Z-plasty, local tissue rearrangement, or skin grafting (graft harvest included when performed).

Verified May 8, 2026 · 6 sources ↓

Medicare: $228.13
Total RVUs: 6.83
Global, days
Region: Hand

Drawn from CMSCgsmedicareFindacode

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify which digit(s) were released, by name and number (e.g., ring finger, digit 4), with the PIP joint involvement documented explicitly.
Record the degree of flexion contracture at the MCP and PIP joints pre-operatively — many payers require quantified contracture severity for medical necessity.
Document whether Z-plasty, local tissue rearrangement, or skin grafting was performed; if a graft was harvested, note the donor site.
Operative note must identify the primary procedure (26123) to which 26125 is being added — the add-on relationship must be clear.
State the approach and extent of fascia excised for each digit released; vague language like 'standard fasciectomy' invites audit flags.
Document functional impairment (inability to fully extend finger, interference with ADLs) supporting medical necessity, particularly for commercial payers.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity LT Left side RT Right side 59 Distinct service 78 Unplanned return — related 79 Unrelated during global

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 26125 covers a partial palmar fasciectomy that extends to release a single digit — including the PIP joint — as part of Dupuytren's contracture treatment. The procedure may incorporate Z-plasty, local tissue rearrangement, or skin grafting; when a graft is harvested, that work is bundled into this code. It is an add-on code to 26123 (partial palmar fasciectomy without digit release), reported once per additional digit released beyond the primary palmar procedure.

26125 carries a ZZZ global period, meaning it has no standalone global package — it inherits the global period of the primary procedure it accompanies. Because it is an add-on code, modifier 51 is not appended. If multiple additional digits are released, report 26125 once for each additional digit.

Top billing specialties are hand surgery, plastic and reconstructive surgery, and orthopedic surgery. Payer policies on medical necessity — particularly documentation of contracture degree and functional impairment — vary; some commercial payers require a minimum flexion contracture (commonly ≥30° at the MCP or any PIP involvement) before authorizing surgery.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	4.49
Practice expense RVU	1.48
Malpractice RVU	0.86
Total RVU	6.83
Medicare national rate	$228.13
Global period	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	$228.13

Common denial reasons

The recurring reasons claims for CPT 26125 get rejected.

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

Billed without the required primary code 26123 — 26125 is an add-on and cannot stand alone on a claim.
Modifier 51 incorrectly appended — 26125 is exempt from multiple-procedure reduction as an add-on code.
Insufficient documentation of contracture severity or functional impairment to satisfy commercial payer medical necessity criteria.
Digit identity or PIP joint involvement not specified in the operative note, causing payer to question whether a higher-complexity release was actually performed.
Units billed incorrectly — each additional digit requires a separate unit of 26125; billing one unit for two additional digits under-reports or causes a mismatch with the operative note.

Frequently asked questions

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

01Can 26125 be billed without 26123 on the same claim?

No. 26125 is an add-on code to 26123. Submitting 26125 alone will deny. The primary palmar fasciectomy (26123) must appear on the same claim, same date of service.

02How many times can 26125 be reported in a single operative session?

Once per additional digit released beyond the primary palmar procedure. If two additional digits are released, report 26125 twice. Confirm your units match the operative note exactly.

03Should modifier 51 be added to 26125 when billed with 26123?

No. 26125 is a designated add-on code and is exempt from modifier 51. Appending modifier 51 can trigger an improper multiple-procedure reduction.

04What global period applies to 26125?

ZZZ — 26125 has no independent global period. It inherits the global period of the primary procedure (26123) it is reported with. Post-op services fall under the primary code's global package.

05What ICD-10 diagnosis code supports 26125?

M72.0 (Palmar fascial fibromatosis — Dupuytren's) is the standard primary diagnosis. Code to the specific hand using laterality (M72.01 right, M72.02 left) when your encoder supports it, and document the affected digit in the medical record.

06Do commercial payers require prior authorization for 26125?

Many do, and requirements vary. Several commercial payers require documented flexion contracture of ≥30° at the MCP joint or any PIP joint involvement before approving surgery. Check individual payer policies and submit contracture measurements with the auth request.

07Is skin grafting separately billable when performed during 26125?

No. When a graft is obtained and applied as part of the digit fasciectomy, the work is bundled into 26125. Separately billing a graft code for the same digit on the same date would be unbundling.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures the specific digit released, the degree of PIP and MCP flexion contracture measured intraoperatively and pre-op, whether Z-plasty or grafting was performed, and the primary procedure performed in the same session. That detail directly prevents the two most common denials: missing add-on primary code linkage and undocumented contracture severity that triggers medical necessity rejection.

See how Mira captures CPT 26125 documentation