Synovectomy of a proximal interphalangeal (PIP) joint of the finger, including extensor tendon reconstruction, reported per joint.

Verified May 8, 2026 · 6 sources ↓

Medicare: $480.64
Total RVUs: 14.39
Global, days: 90
Region: Hand

Drawn from CMSAAPCEmednyAAOSFastrvu

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 digit(s) operated on by name and number — finger modifiers are required for accurate MUE tracking
Document synovial pathology (e.g., rheumatoid pannus, chronic synovitis) with preoperative imaging or biopsy correlation when available
Operative note must describe both the synovectomy and extensor reconstruction components — omitting the extensor work leaves the code under-supported
Include diagnosis linking the procedure to the underlying condition (e.g., rheumatoid arthritis, M06.x) to satisfy medical necessity requirements
If multiple joints are treated in the same session, each requires its own documented approach and intervention in the op note

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 51 Multiple procedures 58 Staged or related 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

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 26140 covers surgical removal of the synovial membrane at a proximal interphalangeal (PIP) joint combined with extensor tendon reconstruction, performed as a single procedure per joint. It's most commonly indicated for rheumatoid arthritis, where synovial proliferation destroys joint architecture and compromises the extensor mechanism. The code applies to one PIP joint — bill it once per joint treated, using the appropriate finger modifier (F1–F9) to identify the specific digit.

The 90-day global period applies. All routine post-op management, wound care, and related E/M visits within that window are bundled. If a separate, unrelated E/M is needed during the global, append modifier 24. If the same procedure is repeated on a different finger during a subsequent encounter in the global window, modifier 79 (unrelated procedure, different site) or 58 (staged) may apply depending on clinical intent — document that intent in the original operative note.

For DIP joint synovectomy, 26140 does not apply — there is no CPT code specific to the DIP. In that scenario, use an unlisted hand procedure code and crosswalk to 26130 or 26140 with documentation explaining the comparison.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	6.18
Practice expense RVU	7.02
Malpractice RVU	1.19
Total RVU	14.39
Medicare national rate	$480.64
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	$480.64
HOPD (APC 5112) Hospital outpatient department	$1,642.82
ASC (PI A2) Ambulatory surgical center (freestanding)	$872.87

Common denial reasons

The recurring reasons claims for CPT 26140 get rejected.

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

Missing or incorrect finger modifier (F1–F9) causes MUE edits or ambiguous claim adjudication
Diagnosis code mismatch — using a nonspecific joint pain code instead of an inflammatory arthropathy code fails medical necessity review
Billing without documenting the extensor reconstruction component invites downcoding or denial for incomplete procedure support
Attempting to use 26140 for a DIP joint — this code is PIP-specific; DIP synovectomy requires an unlisted code
Unbundling related tendon or joint procedures performed at the same site without adequate NCCI modifier justification

Frequently asked questions

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

01Can 26140 be billed for multiple fingers in the same session?

Yes. Bill one unit of 26140 per PIP joint treated, each with the appropriate finger modifier (F1–F9) to identify the digit. Do not stack units on a single line without modifiers — MUE values for finger procedure codes are set at one, with the expectation that modifiers distinguish separate digits.

02What modifier do I use if I'm only doing the synovectomy without extensor reconstruction?

26140 inherently includes both components. If only a synovectomy was performed without extensor reconstruction, 26140 is not the correct code — consider 26130 (synovectomy, carpometacarpal joint) or an unlisted code if the procedure truly doesn't match any descriptor. Document exactly what was done; don't force-fit 26140.

03Is there a CPT code for DIP joint synovectomy?

No. 26140 is PIP-specific. For DIP joint synovectomy, use the unlisted hand procedure code and crosswalk to 26130 or 26140 in your documentation, explaining the anatomic and work comparisons to justify payment.

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

The 90-day global period covers the surgery itself, the day-before preoperative visit, and all routine post-op care through day 90. Unrelated E/M services in that window need modifier 24. A staged return for additional joints or related procedures uses modifier 58.

05Which ICD-10 codes are typically accepted for 26140?

Rheumatoid arthritis codes (M05.x, M06.x) are the primary drivers. Chronic post-infectious synovitis (M65.x) and other specified inflammatory arthropathies may also support medical necessity depending on the payer. Nonspecific joint pain codes (M79.x) routinely trigger medical necessity denials for this procedure.

06Can 26140 and 26135 be billed together if both PIP and MCP joints are treated on the same finger?

They describe procedures at anatomically distinct joints, so billing both with appropriate finger modifiers and documented intervention at each joint is supportable. Check NCCI PTP edits for this pair before submitting, and ensure the operative note documents distinct work at each joint level.

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 finger and joint level from dictation, confirms documentation of both the synovectomy and extensor reconstruction steps, and flags if the extensor repair narrative is absent — the single most common reason this code is challenged on audit. It auto-suggests the correct finger modifier (F1–F9) based on dictated digit, preventing the claim from landing in MUE review.

See how Mira captures CPT 26140 documentation