Manual manipulation of a single Dupuytren's palmar fascial cord performed the day after collagenase enzyme injection to break the softened cord and restore finger extension.

Verified May 8, 2026 · 6 sources ↓

Medicare: $124.25
Total RVUs: 3.72
Global, days: 10
Region: Hand

Drawn from CMSAAPCPayerpriceGenhealthMdclarity

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Date of the prior collagenase injection — required to establish the two-step sequence and justify separate billing
Which specific cord was manipulated (e.g., ring finger palmar cord) and which digit(s) were affected
Pre- and post-manipulation range of motion measurements, including passive extension deficit in degrees
Confirmation that a single cord was treated; document separately if more than one cord was addressed
Notation of any anesthesia used (local, digital block, or none) during the manipulation visit
Post-procedure splinting or extension orthosis instructions if applied

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 59 Distinct service 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 26341 covers the manipulation visit that completes the two-step collagenase (Xiaflex) protocol for Dupuytren's contracture. The enzyme injection — billed separately, typically 24 hours prior — weakens the cord; 26341 is the follow-up encounter where the physician applies manual force to rupture it and regain passive finger extension. The code is specific to a single cord. Multiple cords on the same hand or bilateral same-day manipulation require additional coding.

The 010 global period means post-procedure follow-up is included for 10 days. The injection encounter is not part of this global — it occurs before the manipulation and is billed independently. If the enzyme injection and manipulation are separated by the required interval and performed on different dates, no modifier is needed; the dates themselves establish the sequence. Attempting to bill 26341 on the same date as the injection will trigger a denial.

This code is used most by hand surgeons, orthopedic surgeons, and plastic/reconstructive surgeons. It is performed in the office (POS 11) or outpatient hospital setting. The significant HOPD-to-ASC payment differential makes site-of-service selection a real revenue consideration for practices with multiple facility options.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	0.89
Practice expense RVU	2.66
Malpractice RVU	0.17
Total RVU	3.72
Medicare national rate	$124.25
Global period	10 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	$124.25
HOPD (APC 5111) Hospital outpatient department	$252.01
ASC (PI P3) Ambulatory surgical center (freestanding)	$89.63

Common denial reasons

The recurring reasons claims for CPT 26341 get rejected.

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

Manipulation billed on the same date as the enzyme injection — 26341 requires a separate encounter on a different day
Missing documentation of the prior injection date, leading payers to question medical necessity of the manipulation
Bilateral manipulation coded as a single unit without modifier 50, LT, or RT resulting in edit or underpayment
Multiple cords billed as a single unit of 26341 when additional cord manipulation requires separate line-item reporting
Global period overlap if a related hand procedure was recently performed and modifier 79 or 24 was not appended

Frequently asked questions

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

01Can 26341 be billed on the same day as the collagenase injection?

No. The injection and the manipulation are separate encounters on different dates by definition. Billing both on the same date will result in a denial. The injection is typically performed 24 hours before the manipulation visit.

02What code covers the collagenase injection itself?

The enzyme injection into the Dupuytren's cord is reported with CPT 26040 (palmar fasciotomy, percutaneous) or the appropriate injection code depending on technique and payer policy — not 26341. Confirm with your MAC and payer contracts, as coverage and code assignment for the injection step varies.

03How do you bill manipulation of two separate cords at the same session?

26341 describes a single cord. If a second cord is manipulated at the same encounter, report 26341 a second time with modifier 59 or XS appended to the additional line to distinguish it as a separate structure. Document each cord and digit treated explicitly.

04Does the 010 global cover the original injection visit?

No. The 10-day global attaches to the manipulation encounter (26341), not the injection. The injection visit predates the global period and is billed independently. Post-manipulation follow-up within 10 days is bundled.

05Which modifiers are needed for bilateral same-day Dupuytren's manipulation?

Append modifier 50 for a true bilateral code, or bill two lines with LT and RT respectively, depending on payer preference. Some payers require LT/RT instead of 50 — verify before submitting. Document each hand's cord, digit, and extension gain separately.

06Is 26341 covered by Medicare for Dupuytren's contracture?

Medicare covers 26341 when documentation supports medical necessity: a palpable, functionally limiting cord and a prior qualifying enzyme injection. Coverage is subject to LCD policies in your MAC jurisdiction. Check the Medicare Coverage Database for applicable LCDs.

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 injection date, the specific cord and digit treated, pre- and post-manipulation extension deficit in degrees, and whether splinting was applied — all within the dictated encounter note. This prevents the most common denial trigger: a claim for 26341 with no documented link to a prior injection encounter or no measurable outcome recorded.

See how Mira captures CPT 26341 documentation