Reconstruction of a single metacarpophalangeal joint collateral ligament using a tendon or fascial graft, with graft harvest included in the procedure.

Verified May 8, 2026 · 6 sources ↓

Medicare: $799.62
Total RVUs: 23.94
Global, days: 90
Region: Hand

Drawn from CMSNIHAbosAAPC

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 MCP joint by digit number and laterality (LT/RT)
Name the graft type and donor site (e.g., palmaris longus, fascia lata)
Describe the extent of collateral ligament damage requiring reconstruction rather than primary repair
Confirm the operative note distinguishes this procedure from 26540 (suture repair) and 26542 (local tissue advancement)
Document tourniquet time, approach, fixation method if used (e.g., K-wire), and closure by layer
Record clinical indication — chronic instability, failed primary repair, or acute ligament avulsion with tissue loss

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 76 Repeat, same physician 77 Repeat, another physician 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 6 cited references ↓

26541 covers reconstruction of a collateral ligament at a metacarpophalangeal (MCP) joint using a tendon or fascial graft — most commonly a palmaris longus graft harvested from the same operative field. The code includes graft procurement; you don't add a separate harvest code. This is a step up from 26540, which is primary repair with sutures only, and is distinct from 26542, which uses local tissue advancement (e.g., adductor tendon) rather than a free graft.

The 90-day global period covers all routine post-op management through day 90. Any E/M visit for a new or unrelated problem in that window needs modifier 24. A same-day E/M that drives a separately identifiable decision — for example, a new fracture evaluation at the same encounter — needs modifier 25 on the E/M.

Site of service matters here. HOPD and ASC payments differ substantially; see the Site of Service comparison table on this page. Document which MCP joint is involved (specify digit and laterality) and confirm the operative note names the graft source explicitly — auditors flag notes that describe graft use without identifying the donor site.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	8.59
Practice expense RVU	13.7
Malpractice RVU	1.65
Total RVU	23.94
Medicare national rate	$799.62
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	$799.62
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI J8) Ambulatory surgical center (freestanding)	$2,194.00

Common denial reasons

The recurring reasons claims for CPT 26541 get rejected.

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

Operative note documents suture repair only — use 26540 instead; 26541 requires a free tendon or fascial graft
Missing or vague graft source documentation — auditors deny when donor site is not named in the operative report
Laterality not specified — claims lacking LT or RT modifier are rejected by most payers
Same-day E/M billed without modifier 25, triggering bundling denial under the global surgery rules
Upcoding flag when 26542 (local tissue advancement) was actually performed but 26541 was billed

Frequently asked questions

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

01What separates 26541 from 26540 and 26542?

26540 is primary repair with sutures — no graft. 26541 uses a free tendon or fascial graft (e.g., palmaris longus). 26542 stabilizes the joint with local tissue advancement such as the adductor tendon, not a free graft. The operative technique determines the code; don't select based on the degree of instability alone.

02Does 26541 include graft harvest, or do I add a separate harvest code?

Graft procurement is included in 26541. Do not separately bill a harvest code. The descriptor explicitly states 'includes obtaining graft.'

03Can I bill 26541 bilaterally on the same date?

Yes, if the procedure is performed on the same-named joint on both hands. Append LT to one line and RT to the other. Modifier 50 is an alternative but confirm payer preference — some commercial plans require separate line items with LT/RT rather than a single line with modifier 50.

04Is K-wire fixation separately billable when performed with 26541?

Generally no — stabilization techniques used to protect the reconstruction are considered integral to the procedure. However, if a separate skeletal fixation is performed at a distinct site for an independent indication, modifier 59 or XS may support separate billing. Document the distinct indication clearly.

05What modifier applies if 26541 is performed during the global period of a prior hand surgery for an unrelated problem?

Modifier 79 — unrelated procedure during the postoperative period. Modifier 78 is for unplanned return to the OR for a complication related to the original procedure. Don't use 79 and 78 interchangeably; payers audit the distinction.

06How do I handle a same-day E/M when the decision to perform 26541 was made at that visit?

If the E/M is separately identifiable and not just the preoperative assessment bundled into the global, append modifier 57 when the E/M drives a decision for a major procedure (90-day global). Modifier 25 applies to minor procedures (0- or 10-day global). Since 26541 carries a 90-day global, modifier 57 is the correct choice on the E/M.

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 graft type and donor site from dictation, the specific digit and MCP joint reconstructed, the method of fixation, and the surgeon's stated rationale for reconstruction over primary repair. That detail closes the most common audit gap — operative notes that confirm a graft was used but fail to name where it came from or why primary repair was insufficient.

See how Mira captures CPT 26541 documentation