Reconstruction of a single interphalangeal joint collateral ligament using a tendon or fascial graft, reported per joint.

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

• Specify the exact joint reconstructed — state PIP or DIP and the digit by name or number (e.g., right ring finger PIP).
• Confirm graft use in the operative note — document graft type (tendon vs. fascia), source, and harvest site; absence of graft language is an audit flag.
• Document the preoperative diagnosis with ICD-10 specificity, including laterality and acuity (traumatic vs. chronic instability vs. deformity).
• Record intraoperative findings: degree of collateral ligament damage, joint stability before and after reconstruction, and any additional structures addressed.
• If multiple joints are reconstructed in the same session, separately document each joint to support per-joint billing.
• Note any prior treatment failure (conservative management, prior repair) that justifies reconstruction over primary repair.

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 ↓

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

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

Common denial reasons

The recurring reasons claims for CPT 26545 get rejected.

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

• Missing graft documentation — payers deny 26545 when the operative note describes primary repair without a graft, which maps to a different code.
• Laterality modifier absent — claims without LT or RT on finger procedures are routinely rejected or pended by Medicare and commercial payers.
• ICD-10 mismatch — using an unspecified or mismatched diagnosis code (wrong laterality, wrong digit) triggers NCCI edits and payer rejections.
• No prior authorization obtained for reconstructive hand surgery, resulting in post-service denial from commercial payers requiring precertification.
• Unbundling error — billing graft harvest separately when the graft is integral to the 26545 reconstruction; the graft harvest is typically included.