Surgical removal of a previously placed implant — such as a pin, wire, screw, or plate — from the hand or finger.

Verified May 8, 2026 · 6 sources ↓

Medicare: $337.68
Work RVU: 4
Global, days: 90
Region: Hand

Drawn from CMSAAPCMdclarityAAOSFindacode

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 implant type removed (e.g., K-wire, screw, plate, pin) by name in the operative note
Document the exact anatomic location — specify which hand and which digit or metacarpal region
Record the indication for removal (e.g., hardware prominence, infection, migration, planned staged removal)
Describe the surgical approach, incision location, and technique used to isolate and extract the implant
Note whether the procedure was planned/staged from the original surgery or unplanned, to support modifier selection
If modifier 22 is appended, document the specific factors that made the work substantially greater than typical (e.g., scar tissue, hardware embedment, neurovascular proximity)

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 26320 covers the operative extraction of hardware implanted in the hand or fingers. The procedure involves incision, localization, and removal of the implant, which may include K-wires, Kirschner pins, screws, plates, or similar devices placed during a prior hand surgery. It carries a 90-day global period, meaning routine follow-up through day 90 is included in the base payment.

The key distinction coders must know: 26320 is the site-specific code for hand and finger implant removal, and AAOS coding guidance directs its use over the generic 20680 (deep implant removal) when the site is the hand or finger. Using 20680 for hand hardware removal is a common coding error that can draw audit scrutiny or downcoding. If multiple implants are removed from the same anatomic site in the same session, that is still one unit of 26320 — not multiple units.

Site of service matters significantly here. HOPD and ASC payment rates diverge substantially; see the Site of Service comparison table on this page. If the procedure is staged — for example, planned removal of temporary fixation at a set interval after the index procedure — modifier 58 applies when billed within the global period of the original surgery.

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 (4) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (10.11) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	4
Practice expense RVU	5.33
Malpractice RVU	0.78
Total RVU	10.11
Medicare national rate	$337.68
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	$337.68
HOPD (APC 5072) Hospital outpatient department	$1,687.37
ASC (PI A2) Ambulatory surgical center (freestanding)	$742.04

Common denial reasons

The recurring reasons claims for CPT 26320 get rejected.

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

Using 20680 instead of 26320 for hand/finger hardware — payers and auditors expect the site-specific code per AAOS guidance
Billing multiple units of 26320 for removal of several implants from the same anatomic site in a single session — one unit covers all hardware at that site
Missing laterality modifier (LT or RT) — many payers require side designation for hand procedures
Billing without modifier 58 when removal falls inside the global period of the original fixation procedure and was planned
Lack of documented medical necessity for removal — operative note must state the clinical indication, not just 'patient request'

Frequently asked questions

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

01When should I use 26320 instead of 20680 for hand hardware removal?

Use 26320 whenever the implant is located in the hand or fingers. AAOS coding guidance directs 26320 as the site-specific code for this anatomy, superseding the generic 20680. Billing 20680 for hand hardware is a recognized coding error and can result in downcoding or audit flags.

02Can I bill multiple units of 26320 if I remove several screws and a plate in the same session?

No. Per CMS NCCI policy, one unit of service covers all implants removed from the same anatomic site in a single operative session, even through multiple incisions. A second unit is only supportable if implants are removed from a distinct, separate anatomic site.

03Which modifier applies if this removal is planned follow-up from a recent hand ORIF still in global?

Modifier 58 — staged or related procedure by the same physician during the postoperative period. Use it when the removal was anticipated at the time of the original fixation. Do not use modifier 79 (unrelated procedure) for planned hardware removal within the same global episode.

04Is a laterality modifier required for 26320?

Yes for most payers. Append LT or RT to specify which hand. Many Medicare Administrative Contractors and commercial payers will deny or return claims for hand procedures without laterality designation.

05Can I bill a separate E/M on the same day as 26320?

Only if the E/M is for a separately identifiable problem unrelated to the implant removal. Append modifier 25 to the E/M code and document the distinct medical decision-making. A pre-op exam bundled into the surgical decision is not separately billable.

06What ICD-10 codes support medical necessity for 26320?

Common supporting diagnoses include presence of internal fixation device (Z96.69x), pain due to internal orthopedic prosthetic devices (T84.84xA/D), mechanical complication of internal fixation device of hand bones (T84.19xA/D), and infection of internal fixation device (T84.60xA/D). The selected code should match the documented clinical indication for removal.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the implant type and name, the specific digit and hand, the surgical approach, the indication for removal, and whether the procedure was planned from the index surgery or unplanned. That documentation package prevents the two most common denials for 26320: missing laterality and absent medical necessity. It also flags whether modifier 58 or 79 is needed based on the original procedure date captured in the chart.

See how Mira captures CPT 26320 documentation