Surgical reconstruction of a finger joint, restoring articular integrity and function at an interphalangeal or metacarpophalangeal joint.
Verified May 8, 2026 · 6 sources ↓
- Medicare
- $765.88
- Total RVUs
- 22.93
- Global, days
- 90
- Region
- Hand
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 — PIP, DIP, or MCP — and which digit (e.g., right long finger PIP joint)
- Describe the pathology driving reconstruction: chronic instability, articular destruction, volar plate incompetence, or post-traumatic deformity
- Operative note must detail the reconstructive technique used — graft harvest, implant placement, capsulorrhaphy, or tendon-based stabilization — not just 'reconstruction performed'
- Document pre-op imaging findings (X-ray or MRI) confirming joint pathology and correlating with the surgical indication
- If billed with additional hand codes same-day, document distinct anatomic sites or separate injuries for each additional procedure
- Consent and pre-op note should reflect failed conservative management or acute injury severity justifying reconstruction over 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 ↓
CPT 26548 covers open reconstruction of a finger joint — typically an interphalangeal (IP) joint — where the surgeon rebuilds or replaces the joint surface, capsule, or supporting structures to restore alignment and function. Indications include post-traumatic arthritis, Dupuytren's contracture sequelae, volar plate insufficiency with chronic instability, or failed prior repair. The procedure goes beyond simple repair (26540) and implies a more complex reconstructive effort, which is why payers scrutinize documentation carefully for medical necessity and operative detail.
The 90-day global period means all routine hand therapy referrals, wound checks, and splinting adjustments through day 90 are bundled — no separate E/M unless a new or unrelated problem is documented with modifier 24. If the same surgeon performs a related unplanned return to the OR within the global period, bill modifier 78. An unrelated procedure in the same window takes modifier 79.
Bundling conflicts arise frequently when 26548 is submitted alongside 26540 (repair of collateral ligament) or other hand reconstruction codes on the same finger. Work Comp and commercial payers have denied the combination, arguing component bundling. Use modifier 59 or XS only when the procedures address genuinely distinct anatomic sites or separate injuries with clear operative documentation to support it.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 8.01 |
| Practice expense RVU | 13.39 |
| Malpractice RVU | 1.53 |
| Total RVU | 22.93 |
| Medicare national rate | $765.88 |
| 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 | $765.88 |
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 26548 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Bundled into 26540 (collateral ligament repair) when both are performed on the same joint without distinct site documentation
- Medical necessity denial when operative note lacks imaging correlation or description of functional deficit justifying reconstruction
- Global period conflict — post-op E/M or therapy management billed without modifier 24 flagged as included in the 90-day package
- Modifier 59 or XS rejected when documentation doesn't clearly differentiate the reconstructed site from a co-billed procedure on the same finger
- Laterality not specified on the claim, triggering edit or rejection from payers requiring LT/RT on hand procedures
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 6 cited references ↓
01What distinguishes 26548 from 26540?
02Can 26548 be billed bilaterally with modifier 50?
03Does the 90-day global include occupational therapy?
04How should a complication requiring return to OR within the global period be billed?
05Is 26548 payable in an ASC setting?
06What ICD-10 diagnoses support medical necessity for 26548?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02cms.govhttps://www.cms.gov/medicare/coding-billing/national-correct-coding-initiative-ncci-edits
- 03cms.govhttps://www.cms.gov/files/document/2025nccimedicarepolicymanualcompletepdf.pdf
- 04eatonhand.comhttps://www.eatonhand.com/coding/n26548.htm
- 05findacode.comhttps://www.findacode.com/cpt/26548-cpt-code.html
- 06mdclarity.comhttps://www.mdclarity.com/cpt-code/26548
Mira AI Scribe
Mira's AI scribe captures the joint level (PIP/DIP/MCP), digit, and side from dictation, along with the reconstructive technique and graft or implant details. It flags if the operative note lacks a named technique or imaging correlation — the two triggers most likely to produce a medical necessity denial on audit.
See how Mira captures CPT 26548 documentation