Surgical removal of a phalanx (finger bone) from the hand, performed as an open procedure.

Verified May 8, 2026 · 4 sources ↓

Medicare: $547.44
Total RVUs: 16.39
Global, days: 90
Region: Hand

Drawn from CMSAAOS

Documentation requirements

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

Source · Editorial brief grounded in 4 cited references ↓

Specify which phalanx (proximal, middle, or distal) and which digit (index, long, ring, small, thumb) by name — not just 'finger bone.'
State the pathologic indication (osteomyelitis, tumor, fracture nonunion, avascular necrosis) with supporting imaging or biopsy results referenced in the note.
Document whether the resection was complete or partial, and describe the extent of bone removed.
Describe the surgical approach and wound closure technique, including any soft-tissue management or flap coverage.
If multiple digits are addressed, document each digit separately with distinct findings justifying each resection.
If a staged follow-on procedure is anticipated, state that intent explicitly in the operative note to support modifier 58 on the subsequent claim.

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 57 Decision for surgery 58 Staged or related 59 Distinct service 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 4 cited references ↓

CPT 26185 covers open excision of a phalanx of the finger — typically performed for conditions such as osteomyelitis, bone tumors (benign or malignant), avascular necrosis, or severe trauma that renders the bone unsalvageable. The procedure involves surgical exposure of the affected phalanx, complete or partial resection of the bone, and closure with or without soft-tissue reconstruction depending on remaining tissue integrity.

This code carries a 90-day global period, meaning all routine follow-up visits, wound checks, suture and staple removal, and dressing changes through postoperative day 90 are bundled into the surgical payment. Any separately identifiable E/M service during the global window requires modifier 24 (unrelated) or modifier 25 (same-day, significant and separately identifiable). If a staged procedure is planned — for example, subsequent ray amputation or soft-tissue coverage — document that intent in the original operative note and bill the return surgery with modifier 58.

When multiple phalanges are resected from different fingers in the same operative session, each additional digit may warrant a separate line with modifier 59 (or XS where appropriate) to distinguish independent procedures at distinct anatomic sites. Bilateral simultaneous procedures on both hands would require modifier 50. Site-specific modifiers LT and RT apply when the procedure is unilateral.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	6.36
Practice expense RVU	8.69
Malpractice RVU	1.34
Total RVU	16.39
Medicare national rate	$547.44
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	$547.44
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 26185 get rejected.

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

Non-specific operative note that documents 'finger bone removal' without identifying the digit, phalanx level, or pathologic indication — triggers medical necessity denial.
Bundling denial when 26185 is billed same-day with a component procedure that NCCI edits include; modifier 59 or XS required with documentation of distinct anatomic site or separate indication.
Global period violation: post-op E/M visits billed without modifier 24 or 25 during the 90-day global window are automatically denied.
Lack of supporting imaging or pathology documentation to substantiate the diagnosis driving resection, resulting in medical necessity denial.
Incorrect site modifier — omitting LT or RT on unilateral claims when the payer requires laterality for hand procedures.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 4 cited references ↓

01Does 26185 cover partial resection of a phalanx, or only complete removal?

26185 covers excision of a phalanx — the procedure can be complete or partial. Document the extent explicitly. If only a portion is removed, note what remains and why. Auditors look for this detail when the claim is paired with a tumor or infection diagnosis.

02Can I bill 26185 for multiple digits in the same operative session?

Yes. Bill a separate unit for each distinct digit with modifier 59 (or XS) appended to the additional procedures. Each digit must have its own documented indication in the operative note. Multiple units on the same digit are not appropriate under this code.

03What modifiers apply if the patient returns within 90 days for a related procedure on the same hand?

Use modifier 78 for an unplanned return to the OR for a complication directly related to the original procedure (e.g., wound debridement for post-op infection). Use modifier 58 if the return surgery was planned and staged — document that intent in the original operative note. Modifier 79 applies only to a truly unrelated procedure.

04Is 26185 billed differently in an ASC versus a hospital outpatient setting?

The physician fee is the same regardless of site. The facility payment differs — see the Site of Service comparison on this page. The professional claim (CMS-1500) uses the same code; the facility bills separately under OPPS or ASC payment rates.

05When is modifier 22 appropriate for 26185?

Use modifier 22 when the procedure is substantially more work than typical — for example, severe scarring from prior surgery, extensive osteomyelitis requiring complex debridement beyond standard resection, or anatomic distortion from prior trauma. Attach an operative note that quantifies the additional time and complexity. Without documentation, payers routinely deny or ignore the modifier.

06What ICD-10 diagnoses most commonly support medical necessity for 26185?

Common supporting diagnoses include osteomyelitis of the hand (M86.x4x), benign bone tumors of the phalanges (D16.1x-D16.2x), malignant primary or secondary bone lesions, and post-traumatic avascular necrosis or fracture nonunion of a phalanx. The diagnosis must be laterality- and digit-specific to align with the procedure claim.

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 digit name, phalanx level (proximal/middle/distal), surgical indication, extent of resection (complete vs. partial), approach, and closure details directly from dictation. It also flags when multiple digits are addressed and prompts separate documentation for each. This prevents the most common audit trigger for 26185: a vague operative note that fails to tie a specific bone to a specific pathologic finding, which auditors flag as unsupported medical necessity.

See how Mira captures CPT 26185 documentation