Partial resection of a metacarpal bone in the hand, removing a portion of the bone while preserving adjacent structures.
Verified May 8, 2026 · 2 sources ↓
- Medicare
- $471.62
- Total RVUs
- 14.12
- 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 2 cited references ↓
- Specify which metacarpal is resected (first through fifth) and laterality (left or right hand)
- Document the clinical indication — osteomyelitis, tumor, AVN, or post-traumatic deformity — with supporting imaging or pathology correlation
- Operative note must name the surgical approach, extent of bone removed, and how margins or wound bed were managed
- Record neurovascular and tendon status before and after resection to support medical necessity and establish post-op baseline
- If modifier 22 is appended, document specific factors that prolonged the procedure — prior infection, implants, scarring — and estimate additional time
- Pathology specimen submission and results, when excision is for suspected neoplasm or chronic infection
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 2 cited references ↓
CPT 26230 covers partial excision of a metacarpal bone — most commonly performed to address osteomyelitis, benign bone tumors, avascular necrosis, or post-traumatic deformity where complete ray resection is not warranted. The procedure involves removing a defined segment of the metacarpal while leaving adjacent tendons, neurovascular structures, and neighboring digits intact to the extent possible.
The 90-day global period means all routine follow-up — wound checks, suture removal, splinting adjustments, and hand therapy coordination visits — is bundled into the surgical payment through day 90. Unrelated conditions treated in that window need modifier 24 on E/M services; a significant separately identifiable E/M on the same day as surgery needs modifier 25. Billing modifier 22 is appropriate when resection is significantly complicated by prior infection, hardware, or distorted anatomy — but that requires quantifiable documentation of extra time and complexity.
This code is most frequently reported by hand surgeons and plastic/reconstructive surgeons. When performed for osteomyelitis, link the ICD-10 to the specific bone and laterality — generic musculoskeletal infection codes draw scrutiny. If more than one metacarpal is partially resected in the same operative session, modifier 51 applies to the secondary procedure.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 6.31 |
| Practice expense RVU | 6.59 |
| Malpractice RVU | 1.22 |
| Total RVU | 14.12 |
| Medicare national rate | $471.62 |
| 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 | $471.62 |
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 26230 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Missing laterality on the claim or in the diagnosis code, triggering specificity edits
- ICD-10 code too generic — payers want bone-specific, digit-specific osteomyelitis or neoplasm codes, not general M86 or D49 codes
- Modifier 22 appended without documentation quantifying extra time or complexity — payers routinely deny or reduce without this narrative
- Bundling conflict when a concurrent soft tissue procedure is billed without modifier 59 or XS to establish anatomical distinction
- E/M billed same-day without modifier 25, especially at a preoperative visit where the decision to operate was already made
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 2 cited references ↓
01What is the global period for CPT 26230, and what does it include?
02Can I bill 26230 on both hands in the same operative session?
03When is modifier 22 appropriate for 26230?
04How do I code partial metacarpal resection when performed with a soft tissue procedure on the same finger?
05What ICD-10 codes are appropriate when 26230 is performed for osteomyelitis?
06Is CPT 26230 ever reported with modifier 62 for co-surgery?
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/04-chapter4-ncci-medicare-policy-manual-2026-final.pdf
Mira AI Scribe
Mira's AI scribe captures the specific metacarpal number, laterality, surgical approach, extent of resection, and intraoperative findings — including neurovascular and tendon status — directly from dictation. That detail prevents the two most common denial triggers for 26230: missing anatomical specificity and an operative note that says 'bone resected' without documenting what was preserved or why the partial excision was appropriate over complete ray amputation.
See how Mira captures CPT 26230 documentation