Radical resection of a metacarpal bone for tumor — an extensive ostectomy involving removal of substantial bone stock from the hand.

Verified May 8, 2026 · 6 sources ↓

Medicare: $985.99
Total RVUs: 29.52
Global, days: 90
Region: Hand

Drawn from CMSEatonhandNIH

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify which metacarpal was resected (1st through 5th) and document the extent of bone removed
Include pathology or imaging findings confirming tumor involvement requiring radical resection
Document tumor dimensions, margins, and whether reconstruction (graft or implant) was performed
Record the surgical approach and dissection performed to achieve oncologic margins
Note any intraoperative findings that required deviation from the planned procedure

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

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 26250 covers radical resection ostectomy of a metacarpal for tumor. This is not a simple excision or curettage — it requires removal of the entire metacarpal or a major portion of it due to neoplastic involvement. The 90-day global period applies, so routine post-op management, wound checks, and dressing changes through day 90 are bundled. Any separate, unrelated procedure in that window needs modifier 79; a return to the OR for a related complication uses modifier 78.

Site of service matters here. HOPD and ASC payment rates differ significantly — see the Site of Service comparison table on this page. If the case is performed in an ASC, confirm the facility has the implant and reconstruction capability, since metacarpal resection frequently involves bone grafting or implant reconstruction that may trigger additional codes.

Because this code sits in the excision/ostectomy family alongside codes like 26200 (bone lesion removal) and 26205 (removal with graft), payers will scrutinize whether the extent of resection truly supports the 'radical' threshold. Operative note specificity — tumor size, margins taken, bone length resected — is what separates a clean 26250 claim from a downcoded 26200.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	14.83
Practice expense RVU	11.53
Malpractice RVU	3.16
Total RVU	29.52
Medicare national rate	$985.99
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	$985.99
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI J8) Ambulatory surgical center (freestanding)	$2,363.73

Common denial reasons

The recurring reasons claims for CPT 26250 get rejected.

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

Downcoded to 26200 or 26205 when operative note lacks documentation of 'radical' extent of resection
Missing pathology report or imaging to support medical necessity for extensive ostectomy
Global period violation — unrelated E/M or procedure billed without modifier 79 within 90 days
Incorrect site-of-service designation when procedure shifts between planned HOPD and ASC settings
Bundling conflict when reconstruction codes are appended without distinct documentation of separate work

Frequently asked questions

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

01What distinguishes 26250 from 26200 or 26205?

26250 is a radical resection — extensive removal of metacarpal bone stock for tumor with oncologic intent. 26200 removes a bone cyst or benign lesion without radical margins; 26205 adds bone grafting to that limited excision. If the operative note doesn't describe extensive bone removal for neoplasm, payers will remap to 26200 or 26205.

02Can you bill a bone graft code separately with 26250?

Yes, if reconstruction requires a separate bone graft, that work may be separately reportable. Use modifier 59 to distinguish it as a distinct procedural service and document the graft source, size, and fixation separately in the operative note.

03What modifier applies if the patient returns to the OR within 90 days for wound dehiscence at the resection site?

Modifier 78 — unplanned return to the OR for a complication related to the original procedure during the global period. Do not use modifier 79, which is reserved for unrelated procedures.

04Does 26250 require a malignant diagnosis, or can it be used for benign aggressive tumors?

The code is not restricted to malignancy. Giant cell tumor of bone, aggressive enchondroma, or other benign-but-destructive tumors requiring radical resection can support 26250 — but the operative note and ICD-10 diagnosis must reflect the extent and nature of the lesion.

05Is 26250 subject to SNF consolidated billing?

Yes. Per CMS transmittal guidance, 26250 falls under SNF consolidated billing provisions. If the patient is in a qualifying SNF stay, the SNF is responsible for payment — bill the SNF, not Medicare Part B directly.

06Can 26250 be billed bilaterally with modifier 50?

Bilateral metacarpal tumor resection is extremely rare, but modifier 50 is technically applicable if both hands require simultaneous radical resection. Payers will require independent documentation of tumor involvement in each hand and may request operative reports for both sides before adjudicating.

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 metacarpal number, tumor dimensions and histology, extent of bone resected (length and percentage), margin status, and any reconstruction performed (graft type, implant). This prevents downcoding to 26200/26205 by ensuring the operative note reflects the radical nature of the resection rather than a routine lesion excision.

See how Mira captures CPT 26250 documentation