Closed repair of a finger extensor tendon at its distal insertion — the mallet finger procedure — using splinting with or without percutaneous pin fixation.

Verified May 8, 2026 · 6 sources ↓

Medicare: $542.76
Total RVUs: 16.25
Global, days: 90
Region: Hand

Drawn from CMSAAPCPayerpriceEatonhandAxogeninc

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 digit and which zone (zone I is the distal insertion) of the extensor tendon is involved
Document the mechanism of injury — forced flexion at the DIP joint confirming extensor tendon disruption
Confirm closed versus open injury, as an open disruption changes the code selection
Specify the splinting method used (static DIP extension splint, dynamic splint, or both) and whether a percutaneous pin was placed
Record the position of immobilization — DIP joint in full extension or slight hyperextension — in the procedure note
Note laterality (right vs. left hand) and digit clearly in the operative or procedure record
Document radiographic findings if bony mallet (avulsion fracture) was ruled out or identified, distinguishing soft-tissue mallet from bony mallet for accurate coding

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 6 cited references ↓

CPT 26432 covers closed treatment of a disrupted extensor tendon at the distal phalanx, the classic mallet finger injury. No open incision is required; the repair is accomplished through continuous splinting of the DIP joint in extension, with or without a percutaneous Kirschner wire to maintain reduction. This distinguishes it from 26433 (open repair, no graft) and 26434 (open repair with free graft).

The 90-day global period starts on the day of service and bundles all routine post-op visits, splint checks, and pin removals through day 90. Billing a separate E/M during that window requires modifier 24 for unrelated conditions or modifier 25 for a separately identifiable decision made the same day as the procedure. Finger-specific modifiers (F1–F9) identify which digit was treated and are frequently required by commercial payers even when not mandated by Medicare.

Place of service matters here. This procedure is commonly billed from the office (POS 11), but payers have denied claims asserting it must be performed in a facility setting — no CMS rule requires facility POS for 26432. Document the setting and the clinical rationale for performing the procedure in that location.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	4.06
Practice expense RVU	11.4
Malpractice RVU	0.79
Total RVU	16.25
Medicare national rate	$542.76
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	$542.76
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 26432 get rejected.

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

Place-of-service mismatch — payers denying office-based claims without clinical basis; document POS rationale explicitly
Missing or incorrect digit modifier — commercial payers routinely require F1–F9 to identify the affected finger
Unbundling with 26433 or 26434 — open and closed repairs of the same tendon same day are not separately billable
Diagnosis code mismatch — an ICD-10 code for bony mallet (avulsion fracture) paired with 26432 triggers review, since fracture-associated mallet may require different coding
Global period violations — separate E/M or procedure claims filed during the 90-day global without appropriate modifier 24 or 79

Frequently asked questions

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

01Can 26432 be billed from an office setting, or does it require a facility?

CMS has no rule requiring a facility setting for 26432. The AAPC community has flagged payer denials on this point, but they lack regulatory basis. Document the clinical rationale for performing the closed repair in the office and appeal with that documentation.

02What is the difference between 26432, 26433, and 26434?

26432 is closed treatment of the distal extensor tendon with splinting, with or without a percutaneous pin. 26433 is an open primary or secondary repair without graft. 26434 adds a free graft to the open repair. Choose based on whether the skin was incised and whether graft was required — not on injury acuity alone.

03Which digit modifiers apply to 26432?

Medicare does not require digit modifiers for 26432, but most commercial payers do. Use F1–F9 to specify the exact finger. Omitting this when a payer requires it is a leading cause of denial and delayed payment.

04How long is the global period for 26432?

90 days. All routine follow-up visits, splint adjustments, and pin removals within that window are bundled. Use modifier 24 for unrelated E/M visits and modifier 79 for an unrelated surgical procedure performed during the global period.

05If the mallet finger has an associated avulsion fracture (bony mallet), does 26432 still apply?

Not automatically. A bony mallet with significant fragment displacement may be coded differently, potentially as fracture care. If closed splinting is used and the fracture is managed non-operatively, some coders apply 26432 with a fracture ICD-10; others use fracture care codes. Payer policy varies — verify locally before submitting and ensure the operative note and diagnosis code are internally consistent.

06Can 26432 and an E/M code be billed on the same day?

Yes, with modifier 25 appended to the E/M code. The E/M must be separately identifiable — documenting a decision-making process beyond the procedure itself, such as evaluating for neurovascular compromise or ruling out concurrent injury.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures digit identity, injury zone, mechanism (forced DIP flexion), open vs. closed wound status, splint type and DIP joint position, and whether a percutaneous pin was placed — all from dictation. That detail prevents the two most common denials: missing digit identification and diagnosis-code mismatch between soft-tissue and bony mallet finger.

See how Mira captures CPT 26432 documentation