Synovectomy of the metacarpophalangeal joint with intrinsic release and extensor hood reconstruction, reported per digit.

Verified May 8, 2026 · 5 sources ↓

Medicare: $519.38
Work RVU: 6.95
Global, days: 90
Region: Hand

Drawn from CMSAAPCEmednyEatonhand

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Confirm all three procedural elements: synovectomy, intrinsic release, and extensor hood reconstruction — each must appear by name in the operative note.
Specify which digit(s) were treated and laterality (left vs. right hand) — needed to support LT/RT and per-digit billing.
Document the pre-operative diagnosis driving the procedure (e.g., rheumatoid synovitis, extensor tendon subluxation) with a corresponding ICD-10 code.
Record the surgical approach and extent of synovial tissue removed — operative notes that omit scope of resection are audit red flags.
If multiple digits were treated, each digit's procedure must be separately described in the operative note to support multiple-unit billing.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 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 26135 covers surgical removal of diseased or inflamed synovial tissue from a metacarpophalangeal (MCP) joint, combined with intrinsic muscle release and extensor hood reconstruction — all three components in a single operative session on a single digit. The procedure is most commonly performed for rheumatoid synovitis causing MCP joint destruction and extensor tendon subluxation. All three components must be performed and documented; billing 26135 when only a synovectomy was done (without intrinsic release and extensor hood work) is a code-level mismatch that survives initial edit checks but fails audit.

The code carries a 90-day global period. Routine post-op management, dressing changes, and splint adjustments through day 90 are bundled. Separate billing for those services requires modifier 24 (unrelated E/M) or modifier 79 (unrelated procedure). When multiple MCP joints are revised in the same session, report 26135 for each digit — append modifier 51 to the secondary units and use LT/RT to lateralize. Modifier 50 applies only if bilateral same-digit joints are treated simultaneously, which is anatomically unusual here but not impossible in severe rheumatoid disease.

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 (6.95) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (15.55) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	6.95
Practice expense RVU	7.28
Malpractice RVU	1.32
Total RVU	15.55
Medicare national rate	$519.38
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	$519.38
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 26135 get rejected.

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

Operative note documents synovectomy only — omits intrinsic release or extensor hood reconstruction, causing a code-level mismatch.
Missing or ambiguous laterality and digit identification when multiple units of 26135 are billed same-day.
Modifier 51 not appended to secondary digit(s) when billing multiple MCPs in the same session, triggering unbundling edits.
Post-op evaluation billed without modifier 24 or 79 during the 90-day global period, resulting in automatic denial.
ICD-10 diagnosis code does not support medical necessity for all three surgical components (synovectomy, intrinsic release, extensor hood reconstruction).

Frequently asked questions

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

01Can I bill 26135 for just a synovectomy if the intrinsic release was minor?

No. All three components — synovectomy, intrinsic release, and extensor hood reconstruction — must be performed and documented. If intrinsic release or extensor hood work was not done, 26135 is the wrong code. Consider 26075 (arthrotomy/synovectomy, MCP) instead and verify NCCI edits before billing.

02How do I bill when the surgeon revises three MCP joints on the same hand in one session?

Report 26135 for each digit. The first unit bills without modifier 51; append modifier 51 to each additional unit. Use LT or RT to identify the operative hand. Each digit's procedure must be individually documented in the op note.

03What modifier applies if the patient returns to the OR during the 90-day global for a related MCP issue on the same hand?

Use modifier 78 — unplanned return to the OR for a related procedure during the postoperative period. Do not use modifier 79, which is reserved for unrelated procedures.

04Is 26135 appropriate for a PIP joint synovectomy with extensor reconstruction?

No. 26135 is specific to the metacarpophalangeal joint. Proximal interphalangeal joint synovectomy with extensor reconstruction is reported with 26140.

05Does the 90-day global period affect billing for therapy referrals or splinting?

Hand therapy and custom splint fabrication billed by separate providers (OT/PT) are not bundled into the surgeon's global — those services bill independently. What's bundled is the surgeon's own post-op visits, wound checks, and dressing changes through day 90.

06When does modifier 22 apply to 26135?

Use modifier 22 when the procedure is substantially more complex than typical — for example, severe fibrosis, prior failed surgery, or extensive involvement requiring significantly increased operative time. You must attach a cover letter quantifying the increased work; without it, most payers deny the add-on.

Sources & references

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

Mira Scribe

Mira's AI scribe captures all three operative elements from dictation — synovectomy extent, intrinsic release confirmation, and extensor hood reconstruction technique — along with digit number and laterality. This prevents the most common 26135 audit flag: an operative note that supports only a synovectomy when the code requires all three components to be documented.

See how Mira captures CPT 26135 documentation