Radical resection of a tumor involving the proximal or middle phalanx of a finger, removing bone and surrounding tissue en bloc.

Verified May 8, 2026 · 7 sources ↓

Medicare: $745.84
Work RVU: 10.88
Global, days: 90
Region: Hand

Drawn from CMSAAPCFastrvuEmednyAAOS

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Specify which finger and which phalanx (proximal vs. middle) was resected — vague laterality is an audit flag.
Document tumor characteristics: size, location, imaging findings, and whether the lesion is primary, recurrent, or metastatic — these justify radical vs. simple excision.
Include the surgical approach and extent of resection, naming the bone segment and soft tissue margins removed en bloc.
Pathology report confirming the tumor type must correlate with the ICD-10 diagnosis code used.
If modifier 22 is appended for increased complexity (e.g., prior surgery, neurovascular involvement), the operative note must explicitly quantify the additional work performed.
For staged reconstruction planned at time of initial surgery, document that intent in the original operative note to support modifier 58 on the follow-up claim.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 24 Unrelated E/M during global 25 Significant separate E/M 51 Multiple procedures 57 Decision for surgery 58 Staged or related 59 Distinct service 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 26260 covers radical resection of the proximal or middle phalanx of a finger — typically performed for aggressive, recurrent, or metastatic bone tumors where simple curettage or marginal excision is insufficient. The surgeon removes the affected phalanx along with a margin of healthy surrounding tissue. This distinguishes it from 26210 (simple excision or curettage of a benign bone tumor) and from 26115/26116 (soft tissue tumor excision), where bone resection is not the primary target.

The 90-day global period means all routine follow-up — wound checks, dressing changes, suture removal, and standard post-op visits — is bundled through day 90. An E/M billed during that window for an unrelated problem needs modifier 24. If the decision for surgery was made at the same encounter as the procedure, append modifier 57 to the E/M. For staged procedures anticipated at the time of initial surgery (e.g., planned reconstruction), use modifier 58 on the return visit.

Not to be confused with 26262 (radical resection, distal phalanx) or 26250 (radical resection of metacarpal). Per NCCI Chapter 4, procedures on individual fingers must use digit-specific modifiers (FA, F1–F9) when the same code is billed for more than one finger on the same date. The MUE for this code is set at one unit per finger; use the appropriate finger modifier to report multiple digits rather than increasing units.

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 (10.88) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (22.33) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	10.88
Practice expense RVU	9.12
Malpractice RVU	2.33
Total RVU	22.33
Medicare national rate	$745.84
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	$745.84
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 26260 get rejected.

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

Wrong code level selected — payers deny 26260 when documentation supports only simple curettage (26210), not radical resection with en bloc margins.
Missing or mismatched digit modifier (FA, F1–F9) when multiple fingers are treated on the same date, triggering MUE edits.
ICD-10 diagnosis does not support radical resection — using a benign, non-aggressive tumor code without documentation of recurrence or aggressive behavior.
E/M billed same-day during the 90-day global without modifier 24 or 25, causing automatic bundling denial.
Bilateral or multi-finger procedures billed as increased units rather than with the correct digit-specific modifiers, rejected by NCCI edits.

Frequently asked questions

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

01What separates 26260 from 26210?

26210 is simple excision or curettage of a benign bone tumor of the phalanx. 26260 is radical resection — en bloc removal of the phalanx with surrounding tissue margins, used for aggressive, recurrent, or malignant tumors. Coding one when documentation supports the other is a top audit finding.

02When do I use digit modifiers versus modifier 50?

Use digit-specific modifiers FA or F1–F9 for finger procedures, not modifier 50. Modifier 50 applies to true bilateral procedures (same procedure on both sides of the body). Per NCCI Chapter 4, finger procedures require the finger modifier to distinguish multiple same-day services and satisfy MUE requirements.

03Can I bill an E/M on the same day as 26260?

Only if the E/M is significant and separately documented beyond the pre-surgical assessment. Append modifier 25 to the E/M on the day of surgery, or modifier 24 if the E/M falls during the 90-day global period and is for an unrelated problem.

04Does 26260 include bone graft if needed during the resection?

No — if autograft is obtained and applied, that work may be separately reportable. Confirm with the specific graft CPT code and document graft harvest site separately in the operative note. Check NCCI edits for the graft code pairing before billing.

05How do I bill if the same radical resection is performed on two fingers at the same session?

Report 26260 twice — once for each finger — using the appropriate digit modifiers (e.g., F1 on one line, F2 on another). Apply modifier 51 to the second procedure. Do not bill two units on a single line; NCCI will deny the duplicate.

06When is modifier 22 appropriate for 26260?

Append modifier 22 when documented circumstances substantially increase operative difficulty — prior failed surgery with scar distortion, extensive neurovascular involvement, or unusually large tumor requiring complex reconstruction. The operative note must describe the added work explicitly; a generic mention of 'difficult case' is insufficient.

Sources & references

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

Mira Scribe

The Mira AI Scribe captures the specific finger, phalanx level (proximal vs. middle), tumor size and behavior (primary, recurrent, or metastatic), extent of bony and soft tissue resection, and margins achieved from the surgeon's dictation. This prevents the most common downcode denial — payers flagging 26260 as unsupported when the note reads like a simple curettage instead of a radical en bloc resection.

See how Mira captures CPT 26260 documentation