Surgical excision of a tumor or cyst arising from a tendon sheath in the hand or finger, requiring complete removal of the lesion and its sheath attachment.
Verified May 8, 2026 · 6 sources ↓
- Medicare
- $657.66
- Total RVUs
- 19.69
- Global, days
- 90
- Region
- Hand
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 6 cited references ↓
- Operative note explicitly identifies the lesion as arising from tendon sheath, not subcutaneous tissue
- Anatomic location specified: digit number, tendon sheath level (A1, A2 pulley, flexor/extensor sheath, etc.)
- Description of dissection technique and relationship of lesion to adjacent tendons and neurovascular structures
- Laterality documented (left vs. right hand) to support LT/RT modifier
- Pathology specimen submitted with clinical correlation; report retained in chart
- Preoperative diagnosis supported by clinical exam and/or imaging (ultrasound or MRI) confirming sheath-based lesion
- If multiple lesions excised same session, each distinct lesion site and structure of origin documented separately
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 6 cited references ↓
CPT 26160 covers surgical removal of a lesion — most commonly a giant cell tumor of tendon sheath (GCTTS) or ganglion cyst — originating from a tendon sheath structure in the hand or fingers. The procedure requires open dissection to the sheath, careful separation of the lesion from surrounding tendons and neurovascular structures, and excision of the involved sheath segment. Because GCTTS in particular tends to wrap around flexor tendons and pulleys, the operative note must reflect the anatomic complexity and extent of dissection — not just state that a mass was removed.
The 90-day global period covers all routine postoperative care through day 90. Unrelated visits in that window need modifier 24; a separately identifiable E/M on the day of surgery needs modifier 25. If a concurrent procedure is performed on a distinct structure or digit — such as trigger finger release or a separate cyst on a different finger — modifier 59 or the appropriate XS modifier must be supported by documentation of the distinct site.
Denials frequently turn on inadequate documentation of lesion origin. Payers distinguish between a lesion arising from tendon sheath (26160) versus a subcutaneous soft tissue mass not involving the sheath (reported elsewhere). The operative note must explicitly state the structure of origin. Pathology confirmation of GCTTS or ganglion with sheath involvement strengthens the record and is standard of care given recurrence risk.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 3.48 |
| Practice expense RVU | 15.55 |
| Malpractice RVU | 0.66 |
| Total RVU | 19.69 |
| Medicare national rate | $657.66 |
| 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 | $657.66 |
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 26160 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Operative note describes a 'mass removal' without specifying tendon sheath origin, triggering a coding mismatch denial
- Bundling denial when 26160 is billed same-day with a code for a procedure on the same tendon sheath without a supported distinct-site modifier
- Laterality modifier missing or inconsistent between operative note, superbill, and claim form
- Medical necessity not established — no preoperative documentation of symptom duration, functional limitation, or failed conservative management
- Global period violation — postoperative visit billed without modifier 24 when presenting complaint is related to the excision
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 6 cited references ↓
01Can 26160 be billed for a digital mucous cyst?
02What modifier is needed if two tendon sheath lesions are excised from different digits in the same session?
03Does 26160 bundle with trigger finger release (26055) performed on the same finger?
04What ICD-10 codes pair with 26160?
05Is modifier 22 ever appropriate for 26160?
06How does site of service affect reimbursement for 26160?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02cms.govhttps://www.cms.gov/files/document/2025nccimedicarepolicymanualcompletepdf.pdf
- 03cms.govhttps://www.cms.gov/medicare/coding-billing/ncci-medicaid/medicaid-ncci-policy-manual
- 04aapc.comhttps://www.aapc.com/codes/cpt-codes/26160
- 05aapc.comhttps://www.aapc.com/blog/28071-understand-modifier-59-and-ncci-bundling/
- 06aaos.orghttps://www.aaos.org/quality/coding-and-reimbursement/
Mira AI Scribe
Mira's AI scribe captures the tendon sheath structure of origin, affected digit and level (e.g., flexor sheath at A2 pulley, ring finger left hand), dissection technique, and relationship of the lesion to adjacent tendons and neurovascular bundles — the exact language auditors look for when distinguishing 26160 from a generic soft-tissue excision. This prevents the most common denial: an operative note that documents a mass removal without anchoring the lesion to the tendon sheath.
See how Mira captures CPT 26160 documentation