Excision or curettage of a bone cyst or benign tumor of the metacarpal, with autograft harvest and application to fill the resultant defect.

Verified May 8, 2026 · 6 sources ↓

Medicare: $576.17
Work RVU: 7.73
Global, days: 90
Region: Hand

Drawn from CMSNIHFindacodeAAPCMdclarity

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Identify the specific metacarpal involved (1st–5th) by name or number
Record lesion dimensions and whether excision or curettage technique was used
Document graft harvest site (e.g., distal radius, iliac crest) and volume of graft obtained
Confirm pre-operative imaging (X-ray or MRI) supporting benign or cystic diagnosis
Note surgical approach by name — dorsal incision over the affected metacarpal
Pathology submission documentation if specimen was sent for histologic confirmation

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 52 Reduced services 58 Staged or related 59 Distinct service 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 26205 covers surgical removal or curettage of a bone cyst or benign tumor located in a metacarpal bone, combined with autogenous bone grafting. The surgeon accesses the lesion through a dorsal incision, excises or curettes the cyst or tumor down to healthy bone margins, then harvests autograft — typically from the distal radius or iliac crest — and packs it into the cavity. Autograft harvest is included in this code; do not bill a separate harvesting code.

The 90-day global period includes the day-before visit, the surgery, and all routine post-op management through day 90. Any encounter for an unrelated problem during that window requires modifier 24 (E/M) or modifier 79 (unrelated procedure). A complication requiring return to the OR for a related reason uses modifier 78.

Document lesion location by specific metacarpal (first through fifth), surgical approach, dimensions of the lesion and resulting defect, graft harvest site, and graft type and volume. Operative notes that omit these specifics are the primary audit trigger for this code.

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 (7.73) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (17.25) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	7.73
Practice expense RVU	7.88
Malpractice RVU	1.64
Total RVU	17.25
Medicare national rate	$576.17
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	$576.17
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI A2) Ambulatory surgical center (freestanding)	$3,695.53

Common denial reasons

The recurring reasons claims for CPT 26205 get rejected.

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

Missing or vague ICD-10 diagnosis — benign tumor vs. cyst must be specified; M85.x4 or D16.1–D16.4 range required
Operative note lacks documentation of autograft harvest, causing payer to question whether 26205 (with graft) vs. 26200 (without graft) was correctly selected
Separate graft harvest code billed alongside 26205 — harvest is bundled; billing it separately triggers NCCI edit denial
Failure to append modifier 79 or 78 when billing a second procedure during the global period of a prior hand surgery
Missing pre-operative imaging to support medical necessity of surgical excision over observation

Frequently asked questions

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

01What is the difference between CPT 26200 and CPT 26205?

26200 covers excision or curettage of a metacarpal bone cyst or benign tumor without grafting. 26205 requires autograft harvest and placement into the defect. If you packed the cavity with allograft or synthetic bone substitute only — not autograft — 26205 does not apply; use 26200 and bill the graft material separately if applicable.

02Is autograft harvest billed separately with 26205?

No. Autograft harvest is included in the work of 26205. Billing a separate harvest code alongside 26205 will trigger an NCCI bundling edit and denial.

03Which ICD-10 codes are typically paired with 26205?

Common pairings include M85.34–M85.344 (solitary bone cyst of hand), D16.1–D16.4 (benign neoplasm of short bones of upper limb), and M85.64 (other cyst of bone, hand). The specific code depends on pathology and affected metacarpal. A vague or unspecified diagnosis code is a frequent denial trigger.

04Can 26205 and 26200 be billed together for the same hand during the same operative session?

Only if distinct metacarpals are treated with different techniques — one with autograft and one without. Document each lesion's location, technique, and graft use separately. Append modifier 59 to the secondary code and ensure the operative note supports two separate lesion sites.

05What modifier applies if the patient returns to the OR during the 90-day global for a wound complication at the same site?

Use modifier 78 — unplanned return to the OR for a complication related to the original procedure. Do not use modifier 79 (that is for an unrelated procedure performed during the global period).

06Does site of service affect reimbursement for 26205?

Yes, significantly. HOPD and ASC payments differ — see the Site of Service comparison table on this page. Physician work RVUs are the same regardless of setting, but facility fees and total allowables vary. Performing this in an ASC versus a hospital outpatient department has a material impact on total facility reimbursement.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the specific metacarpal number, lesion type (cyst vs. benign tumor), lesion dimensions, curettage vs. en bloc excision technique, graft harvest site, and graft volume from dictation. This prevents the most common audit flag — operative notes that document tumor removal but omit autograft harvest details, which leads payers to downcode to 26200.

See how Mira captures CPT 26205 documentation