Surgical excision or curettage of a bone cyst or benign tumor arising from a metacarpal bone of the hand, without bone grafting.
Verified May 8, 2026 · 5 sources ↓
- Medicare
- $429.20
- Total RVUs
- 12.85
- 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 5 cited references ↓
- Specify which metacarpal is involved (first through fifth) — not just 'metacarpal bone lesion'
- Document the surgical approach, including dorsal incision and extent of dissection
- Pathology or pre-op imaging confirming cyst or benign tumor (not osteomyelitis, which maps to 26230)
- Operative note must state whether curettage alone or complete excision was performed
- Confirm no bone graft was harvested or placed — if graft used, 26205 applies
- Laterality documented in both the operative note and the order
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 5 cited references ↓
CPT 26200 covers removal or curettage of a bone cyst or benign tumor confined to a metacarpal bone. The surgeon approaches the lesion dorsally, incises the overlying soft tissue, and either excises the lesion en bloc or curettes it from the medullary cavity. No autograft harvest is included — if the defect requires bone grafting, bill 26205 instead.
The 90-day global period means all routine follow-up — wound checks, splint or cast changes, suture removal — is bundled through day 90. Unrelated E/M visits in that window need modifier 24. A staged procedure in the global (e.g., planned grafting after confirming defect size) bills with modifier 58.
Don't confuse 26200 with adjacent codes: 26210 covers the same procedure on a phalanx (proximal, middle, or distal finger bone), not a metacarpal. 26250 is radical resection of a metacarpal tumor — a significantly more aggressive resection with different clinical indications. Laterality modifiers LT and RT are expected by most payers; absent laterality is a common clean-claim failure.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 5.51 |
| Practice expense RVU | 6.26 |
| Malpractice RVU | 1.08 |
| Total RVU | 12.85 |
| Medicare national rate | $429.20 |
| 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 | $429.20 |
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 26200 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Missing laterality modifier (LT or RT) — most payers require it for unilateral hand procedures
- Code billed with bone graft in the record but 26205 not used — payer downcodes or denies 26200 as mismatched
- ICD-10 diagnosis code reflects osteomyelitis or malignancy rather than a cyst or benign tumor, triggering a medical-necessity mismatch
- Procedure billed during the global period of a prior related hand surgery without modifier 58 or 79
- Operative note says 'standard approach' without naming the approach or specifying which metacarpal — audit flag for unsupported coding
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 5 cited references ↓
01What is the difference between CPT 26200 and 26205?
02When should I use 26210 instead of 26200?
03Is modifier 50 appropriate if both hands have lesions excised in the same session?
04What ICD-10 codes are commonly paired with 26200?
05Does 26200 carry a 90-day global period, and what does that include?
06Can 26200 and 26210 be billed together if lesions in both a metacarpal and a phalanx are excised in the same session?
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 metacarpal number, approach description (dorsal incision, extent of dissection), lesion type (cyst vs. benign tumor), curettage vs. excision technique, and whether a bone graft was placed — the key facts that distinguish 26200 from 26205, 26210, and 26250. Capturing laterality and lesion characterization at dictation prevents the two most common clean-claim failures: missing LT/RT modifiers and ICD-10 mismatches on audit.
See how Mira captures CPT 26200 documentation