Partial excision of the proximal or middle phalanx of a finger, performed via craterization, saucerization, or diaphysectomy techniques — typically to address osteomyelitis, tumor, or severely damaged bone.

Verified May 8, 2026 · 6 sources ↓

Medicare: $464.61
Total RVUs: 13.91
Global, days: 90
Region: Hand

Drawn from CMSEatonhandAAPCEmednyAAOS

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 technique used: craterization, saucerization, or diaphysectomy — not just 'partial excision'
Name the exact phalanx resected (proximal or middle) and which finger (index, long, ring, small) to support correct code selection over 26236 or 26230
Document the indication driving the resection — osteomyelitis, benign tumor, tophaceous gout, or other — with supporting pre-op imaging or culture results referenced in the operative note
Record the extent of bone removed and condition of remaining bone margins, including whether debridement margins appeared free of infected or necrotic tissue
Note anesthesia type and any intraoperative imaging used, particularly if fluoroscopy was employed to confirm resection margins
If multiple fingers treated at the same session, document each phalanx by finger name and number as a distinct anatomic site to support modifier 59 use

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 LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 26235 covers surgical partial removal of the proximal or middle phalanx of a finger. The surgeon removes a defined portion of the affected bone using one of three named techniques: craterization (hollowing a crater into the bone), saucerization (creating a saucer-shaped excavation), or diaphysectomy (resecting a segment of the diaphysis). The procedure is most commonly performed for osteomyelitis but also applies to benign bone lesions or structural compromise from tophaceous gout or trauma. Select the correct code based on which phalanx is targeted — 26235 is proximal or middle phalanx, 26236 is distal phalanx, and 26230 is metacarpal.

The global period is 90 days. Routine follow-up wound checks, dressing changes, and suture removal within that window are bundled. If a new, unrelated procedure is performed during the global period, append modifier 79. A return to the OR for a related complication — such as wound debridement for persistent infection — uses modifier 78. Staged re-excision planned at the time of the original surgery uses modifier 58.

Site of service matters here: HOPD and ASC payment rates differ meaningfully (see the Site of Service comparison table on this page). When billing multiple fingers on the same hand at the same session, each additional phalanx requires modifier 59 with clear documentation of distinct anatomic sites. NCCI policy treats contiguous structures within the same anatomic region as a single site, so operative notes must identify each affected phalanx by name and finger.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	6.17
Practice expense RVU	6.55
Malpractice RVU	1.19
Total RVU	13.91
Medicare national rate	$464.61
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	$464.61
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 26235 get rejected.

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

Wrong phalanx code selected — using 26235 when the distal phalanx was actually resected (should be 26236) or when the metacarpal was treated (should be 26230)
Operative note uses vague language like 'partial bone removal' without naming the technique (craterization, saucerization, or diaphysectomy), triggering medical necessity or specificity edits
Multiple fingers billed on the same date without modifier 59 and without distinct anatomic site documentation, causing NCCI bundling denials
Post-op procedure billed during the 90-day global period without the appropriate modifier (58, 78, or 79) to break the bundle
ICD-10 diagnosis code does not support the procedure — e.g., a fracture diagnosis paired with a bone excision code without documentation of infection or lesion requiring excision

Frequently asked questions

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

01What is the difference between CPT 26235 and 26236?

26235 covers partial excision of the proximal or middle phalanx. 26236 covers the distal phalanx. Using the wrong code is a straightforward audit finding — verify which phalanx is documented in the operative note before billing.

02Can 26235 and 26236 be billed together on the same finger?

Only if the operative note documents that both distinct phalanges of the same finger were separately resected. Append modifier 59 to the secondary code and document each as a distinct anatomic site. NCCI treats contiguous structures in the same region as a single site absent clear documentation.

03What modifier applies if the surgeon returns to the OR during the 90-day global to debride recurrent osteomyelitis in the same finger?

Modifier 78 — unplanned return to the OR for a procedure related to the original surgery during the global period. Do not use modifier 79 here; that is reserved for unrelated procedures.

04Does 26235 require a specific diagnosis code, or will any bone condition support it?

The procedure is most commonly paired with osteomyelitis ICD-10 codes (M86.xx series) or benign bone tumor codes. Tophaceous gout with bone destruction is also a recognized indication. A fracture diagnosis alone, without documented infection or lesion, is likely to trigger a medical necessity denial.

05If a staged re-excision is planned at the initial surgery, which modifier is used when the second procedure is billed?

Modifier 58 — staged or related procedure by the same physician during the post-op period. This applies when the second intervention was anticipated or planned at the time of the original surgery, distinguishing it from an unplanned return (modifier 78).

06Can 26235 be billed with an E/M on the same date as surgery?

Only if the E/M represents a separately identifiable decision-making service unrelated to the surgical procedure. Append modifier 25 to the E/M and document the distinct reason for the visit. A routine pre-op assessment for the same condition does not qualify.

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 technique name (craterization, saucerization, or diaphysectomy), the exact phalanx (proximal or middle), and the finger involved directly from surgeon dictation. It also flags the operative indication — osteomyelitis, tumor, or gout — and links it to the supporting diagnosis. This prevents the most common audit trigger: an operative note that names the approach as 'partial excision' without technique specificity, which invites down-coding or medical necessity denials.

See how Mira captures CPT 26235 documentation