Collateral ligament reconstruction at a single metacarpophalangeal joint using local tissue, such as adductor advancement, rather than a harvested tendon or fascial graft.

Verified May 8, 2026 · 7 sources ↓

Medicare: $696.74
Work RVU: 6.78
Global, days: 90
Region: Hand

Drawn from CMSAAPCFindacodeAbosBedrockbilling

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 MCP joint by digit number (e.g., index finger MCP, thumb MCP)
Name the collateral ligament repaired — radial or ulnar — and the pathology found intraoperatively
Explicitly document use of local tissue advancement (e.g., adductor advancement) rather than harvested graft to support 26542 over 26541
Describe the surgical technique: tissue mobilized, advancement method, fixation used (suture anchor, transosseous tunnels, etc.)
Document pre-op imaging or clinical findings establishing instability and medical necessity
Laterality must be recorded — left or right hand — to support LT or RT modifier

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 50 Bilateral procedure 51 Multiple procedures 58 Staged or related 59 Distinct service 76 Repeat, same physician 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 26542 covers reconstruction of a collateral ligament at a single metacarpophalangeal (MCP) joint using local tissue — the classic example being adductor advancement. This distinguishes it from 26541, which requires a harvested tendon or fascial graft, and from 26540, which is a primary repair without reconstruction. Use 26542 when the surgeon advances or realigns adjacent local soft tissue to restore lateral stability at the MCP joint rather than sourcing graft material from elsewhere.

The procedure targets the ligament connecting the metacarpal head to the proximal phalanx. It is indicated for cases where local tissue is sufficient for reconstruction — typically partial or subacute collateral ligament injuries rather than complete chronic tears requiring distant graft augmentation. The 90-day global period applies, so all routine post-op management through day 90 is bundled. Any E/M visit for an unrelated problem during that window requires modifier 24.

Code selection hinges on tissue source: local tissue = 26542, tendon or fascial graft (includes graft harvest) = 26541, primary repair without reconstruction = 26540. Misassigning among these three is the most common audit trigger for this code family. The operative note must explicitly identify the technique and tissue used.

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 (6.78) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (20.86) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	6.78
Practice expense RVU	12.78
Malpractice RVU	1.3
Total RVU	20.86
Medicare national rate	$696.74
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	$696.74
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI J8) Ambulatory surgical center (freestanding)	$2,118.91

Common denial reasons

The recurring reasons claims for CPT 26542 get rejected.

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

Code billed as 26542 but operative note describes a harvested tendon graft — should be 26541; expect downcoding or denial
Missing laterality modifier (LT or RT) causing claim suspension or rejection by payer systems
Lack of documented instability or failed conservative treatment to support medical necessity
Bundling conflict when 26542 is billed same-day with an overlapping MCP procedure without modifier 59 or XS to establish distinct service
Routine post-op E/M visit billed without modifier 24 during the 90-day global period

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 primary repair of a collateral ligament at an MCP or IP joint — no reconstruction. 26541 is reconstruction at a single MCP joint using a harvested tendon or fascial graft, and graft harvest is included. 26542 is also MCP reconstruction but uses local tissue (e.g., adductor advancement) instead of a harvested graft. Tissue source drives the code choice.

02Can I bill 26542 for the thumb MCP joint (gamekeeper's thumb)?

Yes. The thumb MCP ulnar collateral ligament is a common site. Document the thumb digit specifically, identify it as ulnar or radial collateral, and confirm local tissue was used rather than a graft. Laterality modifier (LT or RT) is still required.

03Does the graft harvest get billed separately with 26542?

No. 26542 uses local tissue by definition — there is no separate harvest. If you harvested a tendon or fascial graft, you should be on 26541, which bundles the graft harvest into the code.

04What modifiers are needed when billing 26542 bilaterally?

Append modifier 50 for bilateral procedures billed on a single line, or bill two lines with LT and RT respectively, depending on payer preference. Medicare generally accepts the single-line modifier 50 approach. Confirm the payer's preferred format before submitting.

05How does the 90-day global period affect same-day billing?

All routine post-op care through day 90 is bundled into 26542. If you perform an E/M visit on the same day as surgery for a separately identifiable problem, append modifier 25 to the E/M. Post-op visits for unrelated conditions during the global window require modifier 24.

06Is prior authorization typically required for 26542?

Most commercial payers require prior authorization for MCP ligament reconstruction. Document failed conservative management, clinical instability testing, and imaging findings before submitting the auth request. Some payers also require the operative approach and tissue technique to be specified at the pre-auth stage.

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 digit, collateral ligament (radial vs. ulnar), tissue technique (e.g., adductor advancement), fixation method, and laterality directly from dictation. That detail is what separates a defensible 26542 from a mis-coded 26541 — and it's the first thing an audit team checks when the two codes are billed by the same provider across cases.

See how Mira captures CPT 26542 documentation