Surgical removal of the synovial lining from the carpometacarpal joint — the articulation between a carpal wrist bone and the base of a metacarpal.

Verified May 8, 2026 · 6 sources ↓

Medicare: $458.59
Total RVUs: 13.73
Global, days: 90
Region: Wrist

Drawn from CMSBedrockbillingCgsmedicareFastrvu

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify the exact joint addressed — state 'carpometacarpal joint' by name, not 'wrist joint lining' generically
Document the clinical indication with supporting diagnosis (e.g., rheumatoid arthritis, inflammatory synovitis, refractory synovial disease)
Operative note must describe the surgical approach, extent of synovial tissue excised, and any findings distinct from routine synovitis
Record laterality explicitly (left, right, or bilateral) in both the operative note and the preoperative assessment
If modifier 22 is appended, include a separate attestation paragraph quantifying the increased complexity compared to a typical CMC synovectomy
Document failure of conservative treatment when required by payer prior authorization policies

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 50 Bilateral procedure 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 26130 covers open synovectomy of the carpometacarpal (CMC) joint of the wrist-hand junction. The surgeon excises the inflamed or diseased synovial membrane to reduce pain, limit destructive pannus formation, and restore functional range of motion. Indications include rheumatoid arthritis, inflammatory synovitis, and refractory synovial disease unresponsive to conservative management.

The procedure carries a 90-day global period. All routine post-op visits, wound checks, and stitch removals through day 90 are bundled — bill separately only for unrelated E/M encounters (modifier 24) or new problems addressed same-day pre-operatively (modifier 25). If performed bilaterally in the same session, append modifier 50 on a single claim line for the physician; ASC billing requires two lines with LT and RT.

With 1,249 NCCI PTP edit pairs on record for 26130, bundling exposure is significant. Confirm that any co-billed procedure — particularly arthroscopic or other soft-tissue codes in the same anatomic region — is independently documented and, where the modifier indicator allows, supported by distinct operative note language before appending modifier 59 or an X-modifier to bypass an edit.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	5.45
Practice expense RVU	7.11
Malpractice RVU	1.17
Total RVU	13.73
Medicare national rate	$458.59
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	$458.59
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI A2) Ambulatory surgical center (freestanding)	$1,644.87

Common denial reasons

The recurring reasons claims for CPT 26130 get rejected.

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

Missing or ambiguous laterality — claim processed without LT/RT when payer requires side designation
Bundling denial when co-billed procedure in the same hand region lacks distinct operative documentation and a valid modifier to bypass the NCCI PTP edit
Medical necessity not established — absence of documented conservative treatment failure or inadequate ICD-10 specificity for inflammatory joint disease
Global period violation — routine post-op visit billed within the 90-day global without modifier 24 when encounter is unrelated to the surgery
Incorrect place-of-service code causing facility/non-facility RVU mismatch and underpayment or outright denial

Frequently asked questions

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

01Is 26130 the right code for synovectomy of the radiocarpal joint?

No. CPT 26130 specifically covers the carpometacarpal joint. Synovectomy of the radiocarpal (wrist) joint is reported with a different code. Confirm the exact joint treated in the operative note before selecting the code.

02Can 26130 be billed bilaterally?

Yes. For physician billing, report 26130 with modifier 50 on one claim line. For ASC billing, use two separate claim lines — one with modifier LT and one with modifier RT — each with one unit of service, per NCCI ASC billing rules.

03What ICD-10 codes most commonly support medical necessity for 26130?

Rheumatoid arthritis codes (M05.x, M06.x) with specific wrist/hand site designators are the most common supports. Inflammatory synovitis (M65.x) and post-traumatic synovitis may also apply depending on clinical circumstances. Use the most specific available code and include the laterality character.

04If synovectomy is performed alongside a joint reconstruction or arthroplasty at the same CMC joint, can both be billed?

Not automatically. Check the NCCI PTP edit pair for 26130 against the reconstruction or arthroplasty code. If the modifier indicator is 0, the synovectomy is bundled and not separately payable regardless of documentation. If the indicator is 1 and the procedures are truly distinct, append modifier 59 or an appropriate X-modifier with supporting documentation.

05Does the 90-day global period affect billing for rheumatology or other specialist follow-up after this surgery?

The global period only restricts the operating surgeon's billing. A different physician managing the patient's rheumatologic condition can bill independently for evaluation and management services during the 90-day window without a modifier. The operating surgeon needs modifier 24 for unrelated E/M visits in that period.

06When is modifier 22 appropriate for 26130?

Use modifier 22 only when documented intraoperative findings — extensive adhesions, severely obliterated tissue planes, or unusual anatomic complexity — required substantially more work than a typical CMC synovectomy. Append a written justification to the claim; payers audit modifier 22 aggressively on hand surgery codes.

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 joint name (carpometacarpal), laterality, surgical approach, extent of synovium excised, and the clinical indication driving surgery — all from dictation. That prevents the two most common audit flags for 26130: operative notes that say 'wrist joint' without specifying the CMC articulation, and records that lack a documented failure of non-surgical management required by commercial payers for medical necessity.

See how Mira captures CPT 26130 documentation