Radical resection of a tumor from the distal phalanx of a finger, removing the lesion along with a margin of healthy surrounding bone and tissue.
Verified May 8, 2026 · 7 sources ↓
- Medicare
- $602.22
- Total RVUs
- 18.03
- 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 7 cited references ↓
- Specify the exact digit and laterality (e.g., right ring finger distal phalanx)
- Document tumor characteristics: size, behavior (benign aggressive, malignant, metastatic, recurrent), and preoperative imaging findings
- Describe the surgical approach and extent of resection, including margin intent and whether en bloc removal was achieved
- Record intraoperative or post-resection pathology submission with specimen labeling tied to precise anatomic location
- Distinguish operative intent from simple excision/curettage — note why radical resection was indicated over 26210 or 26236
- Include preoperative diagnosis supported by imaging (X-ray, MRI, or CT) confirming distal phalanx involvement
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 7 cited references ↓
CPT 26262 covers radical resection of a tumor at the distal phalanx of a finger — the most distal bony segment. This is not a simple excision or curettage; radical resection implies en bloc removal of the lesion with surrounding normal tissue margins, used for aggressive benign tumors, recurrent tumors, or malignancies including metastatic lesions. The intent is oncologic clearance, not merely debulking.
The procedure sits in the musculoskeletal hand/finger excision family, distinct from 26210/26215 (excision or curettage of bone cyst or benign tumor of distal phalanx) and 26236 (partial excision for osteomyelitis). When deciding between these, the key driver is tumor behavior and surgical intent: curettage for contained benign lesions, radical resection when clean margins and tissue architecture require wider bone sacrifice. Proximal and middle phalanx radical resection maps to 26260; metacarpal radical resection maps to 26250.
The 90-day global period covers all routine post-op care through day 90. Any unrelated procedure in that window needs modifier 79; a planned staged procedure needs modifier 58. Pathology specimens submitted from the resection are separately reportable under 88300–88309 — if multiple lesions are submitted as distinct specimens with documented separate locations, each may carry its own pathology code per NCCI guidance.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 8.08 |
| Practice expense RVU | 8.23 |
| Malpractice RVU | 1.72 |
| Total RVU | 18.03 |
| Medicare national rate | $602.22 |
| 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 | $602.22 |
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 26262 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Code selected (26262) not supported when operative note describes curettage rather than radical en bloc resection — downcoded to 26210 or 26236
- Missing laterality or digit specificity causes claim suspension or rejection under payer edits requiring site detail
- Pathology code (88300–88309) denied as unbundled when submitted without documentation of a separately labeled specimen from a distinct lesion site
- Global period violation when post-op E/M is billed within 90 days without modifier 24 and documentation that the visit addressed an unrelated problem
- Diagnosis code mismatch — using a benign cyst ICD-10 code for a procedure clearly indicated for malignant or aggressive tumor
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 7 cited references ↓
01What separates 26262 from 26210 or 26236 for a distal phalanx lesion?
02Can 26262 and a pathology code be billed together?
03Does the 90-day global period affect post-op fracture or wound management billing?
04How should I handle bilateral or multi-digit resections on the same operative session?
05Is modifier 22 appropriate for an unusually complex radical resection?
06What ICD-10 diagnoses support 26262 at payer level?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02fastrvu.comhttps://fastrvu.com/cpt/26262
- 03aapc.comhttps://www.aapc.com/codes/cpt-codes/26262
- 04cms.govhttps://www.cms.gov/files/document/03-chapter3-ncci-medicare-policy-manual-2026-final.pdf
- 05abos.orghttps://www.abos.org/wp-content/uploads/2019/12/hand-cpt-updated.pdf
- 06cms.govhttps://www.cms.gov/medicare/coding-billing/national-correct-coding-initiative-ncci-edits
- 07emedny.orghttps://www.emedny.org/providermanuals/physician/pdfs/physician%20procedure%20codes%20sect5.pdf
Mira AI Scribe
The Mira AI Scribe captures the affected digit and laterality, tumor characterization (size, pathologic behavior, recurrence status), surgical approach, and the explicit statement that radical resection with margin was performed rather than curettage. It also flags when the operative note language defaults to 'excision' without specifying margin intent — the leading reason auditors downcode 26262 to 26210.
See how Mira captures CPT 26262 documentation