Excision or curettage of a bone cyst or benign tumor from the proximal, middle, or distal phalanx of a finger, with autograft harvest and application included.

Verified May 8, 2026 · 7 sources ↓

Medicare: $543.10
Work RVU: 7.09
Global, days: 90
Region: Hand

Drawn from CMSMdclarityAAPCFindacodeEatonhand

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Identify the specific digit and phalanx (proximal, middle, or distal) in the operative note
Confirm pathology type — enchondroma, bone cyst, or other benign tumor — with imaging or intraoperative findings documented
Document that autograft was obtained and used to fill the defect; specify donor site
Record lesion size and extent of curettage or excision performed
Include preoperative imaging (X-ray or MRI) supporting the diagnosis of a bone cyst or benign tumor
Pathology specimen submission and report when tissue is sent for histologic analysis

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 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 26215 covers surgical removal or curettage of a bone cyst or benign tumor — such as an enchondroma — from any phalanx of a finger, where the defect requires filling with autogenous bone graft. Obtaining the graft is bundled into the code; don't report a separate graft harvest code. The procedure involves incising the skin, exposing the phalanx, excising or curetting the lesion, and packing the resulting cavity with autograft to restore structural integrity.

The 90-day global period means all routine follow-up — wound checks, suture removal, cast or splint management related to the surgery — is bundled through day 90. Any new problem or unrelated visit during that window requires modifier 24. If the lesion does not require grafting, report 26210 instead; 26215 is specifically for cases where autograft is used. Digit-specific modifiers (F1–F9) are standard for finger procedures and are required by most payers to identify the operative digit.

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 (7.09) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (16.26) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	7.09
Practice expense RVU	7.67
Malpractice RVU	1.5
Total RVU	16.26
Medicare national rate	$543.10
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	$543.10
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI A2) Ambulatory surgical center (freestanding)	$1,644.87

Common denial reasons

The recurring reasons claims for CPT 26215 get rejected.

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

Missing digit-specific modifier (F1–F9) causing claim rejection or processing delay
Billing 26215 when no autograft was used — 26210 is correct for lesion excision without graft
Insufficient documentation linking imaging findings to the operative indication
Unbundling a separate graft harvest code that is already included in 26215
Global period conflict when follow-up visits are billed without modifier 24 within 90 days of surgery

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01What is the difference between CPT 26210 and 26215?

26210 is used when the bone cyst or benign tumor is excised or curetted without a graft. 26215 is the correct code only when autograft is harvested and used to fill the defect. Using 26215 without documented autograft use is a common audit target.

02Is graft harvest separately billable with 26215?

No. Obtaining the autograft is bundled into 26215. Do not report a separate graft procurement code alongside it — payers will deny or reduce the secondary code.

03Which digit modifier should I use with 26215?

Use HCPCS digit modifiers F1–F9 to identify the specific finger operated on. Most commercial payers and Medicare require digit-level identification for hand procedure codes. Omitting the modifier is a leading cause of claim rejection for this code.

04Can 26215 be billed bilaterally if both hands are operated on?

Yes. If the same procedure is performed on corresponding fingers of both hands in the same session, report the code twice with LT and RT modifiers (or modifier 50 per payer preference). Verify the individual payer's bilateral billing policy before submitting.

05What ICD-10 diagnoses support 26215?

Enchondroma of the phalanx (D16.1x for finger bones) is the most common supporting diagnosis. Solitary bone cyst codes also apply. The diagnosis must correspond to a benign lesion — malignant tumors route to different excision codes with different documentation requirements.

06Does the 90-day global period affect post-op office visits after 26215?

Yes. All routine post-op visits related to the surgery are bundled through day 90. Bill an unrelated visit with modifier 24 appended to the E/M code. Bill a related complication requiring a separate procedure with modifier 78 if it's an unplanned return to the OR.

Sources & references

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

Mira Scribe

The Mira AI Scribe captures the operative digit and phalanx level, lesion type, curettage versus excision technique, autograft donor site, and graft application from dictation. That detail prevents the two most common denials for 26215: miscoding to 26210 when autograft is actually used, and missing laterality or digit specificity that triggers payer edits.

See how Mira captures CPT 26215 documentation