Capsulodesis of the metacarpophalangeal joint addressing three or four digits — joint capsule is incised and reattached under increased tension to stabilize the MCP joint against volar or ulnar drift.

Verified May 8, 2026 · 8 sources ↓

Medicare: $855.06
Total RVUs: 25.6
Global, days: 90
Region: Hand

Drawn from CMSFastrvuAbosAAPCBedrockbilling

Documentation requirements

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

Source · Editorial brief grounded in 8 cited references ↓

Specify exact number of digits treated (three or four) — code selection depends on digit count
Identify each digit by name or number (e.g., index, long, ring) in the operative note
Describe the surgical technique: capsule incision, tensioning method, and fixation to metacarpal and phalanx
Document the clinical indication — hyperextension deformity, ulnar drift, volar plate insufficiency, or other instability diagnosis
Record laterality (left vs. right hand) to support LT/RT modifier and match ICD-10 laterality codes
Note any concurrent procedures performed and confirm separate distinct operative steps if billing additional codes

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 52 Reduced services 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 8 cited references ↓

CPT 26518 covers capsulodesis of the metacarpophalangeal joint performed on three or four digits in a single operative session. The surgeon incises the joint capsule and reattaches it with increased tension to the metacarpal and proximal phalanx, restoring passive restraint against instability — most commonly volar plate laxity causing hyperextension deformity or ulnar drift in rheumatoid and post-traumatic presentations.

Code selection within the 26516–26518 family is strictly digit-count driven: 26516 covers a single digit, 26517 covers two, and 26518 covers three or four. Billing 26518 for a two-digit procedure is an overcoding error. If five digits are addressed, coding guidance and payer policy should be reviewed for whether multiple units or a combination with 26517 is appropriate — do not stack 26518 twice.

The global period is 90 days. All routine postoperative care, splint checks, and wound management through day 90 are bundled. Separate billing for unrelated conditions during that window requires modifier 24. If a complication requires a return to the OR for a related procedure, bill with modifier 78. An unrelated procedure in the global window uses modifier 79.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	9.04
Practice expense RVU	14.64
Malpractice RVU	1.92
Total RVU	25.6
Medicare national rate	$855.06
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	$855.06
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$4,682.29

Common denial reasons

The recurring reasons claims for CPT 26518 get rejected.

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

Digit count mismatch: operative note documents two digits but 26518 (three or four) was billed
Missing or inconsistent laterality — ICD-10 laterality does not match modifier LT or RT on the claim
Bundling conflict when 26518 is billed same-day with related MCP capsule or arthroplasty codes without a supporting modifier
Medical necessity not established — no documented instability diagnosis or failed conservative management in the record
Global period violations: postoperative visits billed without modifier 24 during the 90-day global window

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 8 cited references ↓

01What separates 26518 from 26516 and 26517?

Digit count only. 26516 = one digit, 26517 = two digits, 26518 = three or four digits. The procedure is the same; code selection is determined entirely by how many MCP joints are addressed in the session.

02Can 26518 be billed bilaterally if both hands are treated?

Yes. Bill 26518 with modifier 50 (or LT/RT on separate lines per payer preference) if capsulodesis is performed on three or four digits of each hand in the same operative session. Verify bilateral policy with the specific payer — some require separate line items.

03What if five digits require capsulodesis?

26518 covers three or four digits. For five digits, review whether to bill 26518 plus 26516 with modifier 59 or XS to indicate a distinct digit. Document each digit individually and confirm the combination is not NCCI-bundled without an allowable modifier before submitting.

04Does the 90-day global include postoperative hand therapy referrals?

The global bundles the surgeon's own postoperative services. Hand therapy billed by a separate therapist or therapy practice is outside the surgeon's global and bills independently. The surgeon cannot separately bill routine follow-up visits within the 90 days.

05Which ICD-10 codes typically support medical necessity for 26518?

Common supporting diagnoses include MCP joint instability, volar plate insufficiency, rheumatoid arthritis with MCP involvement, and post-traumatic joint laxity. The diagnosis must specify laterality to match the LT or RT modifier on the claim.

06If a manipulation or closed treatment was attempted before surgery, does that affect billing?

Prior nonsurgical management strengthens the medical necessity argument but does not change code selection or global period. Document the failed conservative course in the preoperative assessment.

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 digit count (three vs. four), identifies each digit by name, records the laterality, and documents the capsule incision, tensioning technique, and fixation details from dictation. This directly prevents the most common denial for 26518 — an operative note that names the procedure without confirming digit count, which auditors flag as insufficient to distinguish 26518 from the lower-valued 26516 or 26517.

See how Mira captures CPT 26518 documentation