Surgical repair of a torn collateral ligament at a metacarpophalangeal (MCP) or interphalangeal (IP) joint of the hand.

Verified May 8, 2026 · 7 sources ↓

Medicare: $679.37
Work RVU: 6.44
Global, days: 90
Region: Hand

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Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Identify the specific joint repaired: MCP or IP, and which digit (e.g., thumb MCP, index PIP)
Confirm the procedure is a direct ligament repair — not a reconstruction using graft or local tissue transfer
Document the mechanism and chronicity of injury (acute traumatic tear vs. chronic instability)
Record operative approach, ligament quality, repair technique, and suture method used
Note the side (left or right hand) to support LT/RT modifier assignment
If additional procedures were performed at the same session, document each as a distinct operative step with separate anatomic site notation

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 59 Distinct service 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 26540 covers open repair of a collateral ligament at either a metacarpophalangeal or interphalangeal joint of the hand. The code applies when the native ligament is directly repaired — not reconstructed with graft tissue or local tissue transfer. If graft reconstruction is required at the MCP joint, 26541 (tendon/fascial graft) or 26542 (local tissue advancement) are the correct alternatives. For IP joint reconstruction with graft, use 26545.

The 90-day global period means all routine follow-up, dressing changes, and office visits through day 90 are bundled into the surgical payment. Anything unrelated to the collateral ligament repair billed during that window requires modifier 24 or 25. Same-day procedures on separate structures or joints may be billable with modifier 59 or appropriate X-modifiers, but NCCI edits must be checked — payers have denied codes like 26548, 26115, and 64702 as bundled components when billed alongside 26540.

Side matters for billing: append LT or RT to identify the operative hand. Bilateral repairs on the same day require modifier 50 (one line) or LT/RT on separate lines depending on payer preference. When 26540 is billed alongside other hand procedures in the same session, list the highest-RVU code first and apply modifier 51 to secondary procedures per standard multi-procedure rules.

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 (6.44) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (20.34) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	6.44
Practice expense RVU	12.66
Malpractice RVU	1.24
Total RVU	20.34
Medicare national rate	$679.37
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	$679.37
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI A2) Ambulatory surgical center (freestanding)	$1,644.87

Common denial reasons

The recurring reasons claims for CPT 26540 get rejected.

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

Bundling denial when 26548 or other hand codes are billed same-day without modifier 59 or XS establishing distinct procedural service
Incorrect code selection: using 26540 when graft reconstruction was performed (26541, 26542, or 26545 applies instead)
Missing LT/RT modifier causing claim suspension or rejection for laterality-required payers
Routine post-op visit billed without modifier 24 during the 90-day global period
Operative report describes only 'collateral ligament repair' without specifying which joint or digit, triggering medical necessity review

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01What is the difference between 26540, 26541, and 26542?

26540 is a direct primary repair of the collateral ligament. 26541 is reconstruction at the MCP joint using a tendon or fascial graft (graft harvest included). 26542 is reconstruction at the MCP joint using local tissue such as adductor advancement. If you used graft tissue or a local tissue transfer, 26540 is the wrong code.

02Can 26540 be billed bilaterally?

Yes. If the same collateral ligament repair is performed on both hands in the same session, append modifier 50 on a single line, or bill with LT and RT on separate lines depending on the payer. Reimbursement generally caps at 150% of the single-procedure fee under Medicare.

03How do I bill 26540 with 26715 (open reduction of MCP dislocation)?

When the ligament repair and the open reduction are performed at the same joint during the same session, check NCCI edits before billing both. If the procedures are clinically distinct and separately documented, modifier 59 may support separate billing — but confirm the payer's bundling policy, as some carriers treat the ligament repair as integral to the open reduction.

04What global period applies to 26540, and what does it include?

26540 carries a 90-day global period. That covers the surgery itself, the day-before preoperative visit, and all routine post-op care through day 90. Separate billing for routine follow-up visits in that window will deny. Unrelated E/M services need modifier 24; unrelated procedures need modifier 79.

05If the collateral ligament repair is at an IP joint with graft, which code applies?

Use 26545, which covers collateral ligament reconstruction at the interphalangeal joint with graft. 26540 applies only to direct primary repair; 26541 and 26542 are MCP-specific reconstruction codes and do not cover IP joint reconstruction.

06Does modifier 22 ever apply to 26540?

Yes, when the repair involves substantially increased work — for example, severely attenuated ligament tissue requiring complex technique, or an unusually difficult exposure. Modifier 22 requires a supporting operative note that explains the specific factors adding time and complexity, and most payers require a cover letter with documentation.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the specific joint repaired (MCP vs. IP), digit involved, laterality, mechanism of injury, ligament quality at exploration, repair technique, and any concomitant procedures with their anatomic sites. This prevents the most common audit flag — an operative note that says 'collateral ligament repaired' without specifying which joint or finger, which draws medical necessity scrutiny and supports accurate selection between 26540, 26541, 26542, and 26545.

See how Mira captures CPT 26540 documentation