Partial excision of the distal phalanx of a finger via craterization, saucerization, or diaphysectomy — typically for osteomyelitis or other localized bone pathology.

Verified May 8, 2026 · 7 sources ↓

Medicare: $422.19
Total RVUs: 12.64
Global, days: 90
Region: Hand

Drawn from CMSAAPCBedrockbillingFastrvuFindacode

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Specify the affected digit using the correct finger designation (e.g., right hand, index finger) — supports required digit modifier assignment
Name the surgical technique used: craterization, saucerization, or diaphysectomy — generic terms like 'bone removal' invite downcoding
Document the clinical indication with supporting imaging or culture results — osteomyelitis claims without corroborating diagnosis codes are a common audit flag
Record the extent of bone removed and confirm the distal phalanx as the operative site — distinguishes 26236 from proximal/middle phalanx codes
Include intraoperative debridement details and wound closure method to support medical necessity and global period boundaries
Note anesthesia type used — local vs. general affects facility billing and anesthesia crosswalk accuracy

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 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

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 26236 covers surgical removal of a portion of the distal phalanx using one of three named techniques: craterization (scooping out a focal defect), saucerization (creating a shallow dish-shaped resection), or diaphysectomy (excising a segment of the cortical shaft). The procedure is most commonly indicated for osteomyelitis, but also applies to chronic bone infections, small tumors, or post-traumatic bone abnormalities confined to the fingertip phalanx. The surgeon makes a targeted incision, removes infected or pathologic bone with curets or rongeurs, debrides the surrounding tissue, and closes primarily.

This code carries a 90-day global period. All routine follow-up, wound checks, and dressing changes through day 90 are included. A staged revision, hardware removal, or treatment for a new, unrelated condition in that window requires modifier 58 or 79, respectively. Finger-specific digit modifiers (FA, F1–F9) are required by NCCI policy when the same procedure is performed on more than one finger — MUE values for many finger procedures are set to 1 per digit precisely because of this modifier structure.

The procedure is most frequently reported by orthopedic surgeons and hand surgeons. Place of service matters: HOPD and ASC reimbursements differ significantly (see the Site of Service comparison table). Bilateral same-session work on both hands requires modifier 50; multiple fingers on one hand require individual digit modifiers rather than modifier 50.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	5.32
Practice expense RVU	6.28
Malpractice RVU	1.04
Total RVU	12.64
Medicare national rate	$422.19
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	$422.19
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 26236 get rejected.

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

Missing or incorrect digit modifier (FA, F1–F9) — NCCI policy requires these for finger procedures; omission triggers bundling or MUE denial
ICD-10 diagnosis does not support the procedure — osteomyelitis (M86.xx), bone tumor (D16.1x), or trauma sequela must match the operative site and laterality
Operative note lacks the specific technique name — payers audit for craterization, saucerization, or diaphysectomy; vague language triggers medical necessity review
Unbundling debridement codes billed separately within the same session when debridement is inherent to the partial excision
Global period conflict — post-op services billed without modifier 24 or 58 when a related condition requires additional care within the 90-day window

Frequently asked questions

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

01Which digit modifiers apply to 26236, and are they required?

Yes, digit modifiers FA and F1–F9 are required by NCCI policy when the same procedure is performed on more than one finger. MUE values for most finger procedures are set at 1 per digit, so billing two units without digit modifiers will hit an MUE wall. Even for a single finger, appending the correct digit modifier prevents ambiguity during audit.

02How do I bill 26236 when two fingers on the same hand are treated in the same session?

Bill 26236 twice, each line with a different finger modifier (e.g., F1 for the index, F2 for the long). Do not use modifier 50 — that's reserved for bilateral procedures on both hands. Modifier 51 may apply to the secondary procedure depending on payer rules.

03Can I bill debridement separately alongside 26236?

Generally no. Debridement of the operative site is inherent to the partial excision and is not separately reportable. If you performed a distinct debridement at a separate anatomic site, modifier 59 or XS is required to establish a different location — and the documentation must clearly support it.

04What ICD-10 codes are most commonly paired with 26236?

Osteomyelitis of the finger phalanges (M86.14x, M86.24x, M86.34x depending on type and acuity) is the primary indication. Also used with bone cyst codes (M85.84x) and post-traumatic osteonecrosis or sequelae. Laterality and digit specificity must match the operative report.

05Does the 90-day global period mean I can't bill anything related to the finger for 90 days?

You can't bill routine post-op care — that's included. But if the patient develops a complication requiring a return to the OR for a related procedure, use modifier 78. If you perform a new, unrelated procedure on a different condition within the global, use modifier 79. Office visits for unrelated problems need modifier 24.

06How does 26236 differ from 26262, and when should I use each?

26236 is a partial excision of the distal phalanx — targeted removal for infection or focal pathology. CPT 26262 covers radical resection of the distal phalanx, typically indicated for tumor. The extent of resection and clinical indication drive the distinction. Upcoding 26236 to 26262 for osteomyelitis cases is an audit risk.

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 operative technique by name (craterization, saucerization, or diaphysectomy), the specific digit treated with laterality, the confirmed anatomic site (distal phalanx), the clinical indication (e.g., osteomyelitis with corroborating imaging), and the extent of bone removed. This prevents the two most common denial triggers: a missing or mismatched digit modifier and an operative note that fails to name the technique — both of which draw medical necessity reviews and downcodes.

See how Mira captures CPT 26236 documentation