Pollicization of a digit — surgical reconstruction of a thumb by repositioning a finger (typically the index finger), including its bones, tendons, nerves, and vessels, into the thumb position.

Verified May 8, 2026 · 6 sources ↓

Medicare: $1,538.45
Total RVUs: 46.06
Global, days: 90
Region: Hand

Drawn from CMSMdclarityAAPCEmednyHhs

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Diagnosis supporting thumb absence or non-function — specify congenital (e.g., thumb aplasia/hypoplasia) or post-traumatic etiology with ICD-10 code
Operative note must identify the donor digit (typically index finger) and confirm neurovascular pedicle preservation throughout dissection
Document skeletal shortening, derotation angle, and intrinsic/extrinsic tendon rebalancing steps performed during the procedure
Pre-operative imaging or clinical assessment confirming thumb absence or functional loss sufficient to justify pollicization over alternative reconstruction
If bilateral (both thumbs absent), document each side separately and append LT/RT or modifier 50 with supporting clinical rationale for simultaneous surgery
For congenital cases in pediatric patients, note patient age and weight; procedures on infants under 4 kg may warrant modifier 63 per applicable code family guidelines

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 58 Staged or related 59 Distinct service 62 Co-surgeons 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 26550 covers pollicization: the transfer of a non-thumb digit — almost always the index finger — into the thumb position to create a functional, sensate thumb. The surgeon repositions the entire digit with its neurovascular bundle and skeletal framework, rebalancing intrinsic and extrinsic tendons to restore opposition. It's performed for congenital thumb aplasia or hypoplasia and for traumatic thumb loss where toe-to-hand transfer isn't suitable or preferred.

This is a 90-day global procedure. All routine follow-up visits, wound checks, splint and cast changes, and therapy coordination within 90 days of surgery are bundled. Separate billing within the global window requires modifier 24 (unrelated E/M) or 78/79 for unplanned or unrelated returns to the OR.

Pollicization sits adjacent to toe-to-hand transfer codes (26551–26554) in the CPT family. Do not confuse 26550 with 26555 (finger-to-finger transfer without microvascular anastomosis) — pollicization specifically involves repositioning a digit into the thumb ray and does not require microvascular anastomosis because the neurovascular pedicle is preserved in situ.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	21.14
Practice expense RVU	20.42
Malpractice RVU	4.5
Total RVU	46.06
Medicare national rate	$1,538.45
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	$1,538.45
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 26550 get rejected.

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

Medical necessity not established — documentation lacks confirmation of thumb aplasia, hypoplasia grade, or traumatic loss with functional deficit
Incorrect code selection — payer downcodes to 26555 (finger transfer without microvascular anastomosis) when operative note doesn't clearly distinguish pollicization technique
Global period conflict — post-op E/M or therapy management billed without modifier 24 during the 90-day global window
Missing laterality modifier — payers requiring LT or RT deny claims submitted without side designation for unilateral digit procedures
Bundling conflict with same-session procedures — co-billed soft tissue or bone work denied without modifier 59 or XS establishing a distinct service

Frequently asked questions

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

01What's the difference between 26550 and 26555?

26550 is pollicization — moving a digit into the thumb ray with preserved neurovascular pedicle and skeletal remodeling to recreate thumb function. 26555 is a simple finger transposition to another position without microvascular anastomosis and without the full skeletal/tendon reconstruction of pollicization. They are not interchangeable; the operative technique determines which code applies.

02Does 26550 require microvascular anastomosis?

No. Pollicization preserves the neurovascular pedicle of the transferred digit — it is not divided and reanastomosed. If microvascular anastomosis is performed for a toe-to-hand transfer, use 26551–26554 instead.

03Can I bill 26550 with toe-to-hand transfer codes on the same date?

Not for the same digit or thumb ray. If reconstruction is performed on separate anatomical sites or staged encounters, append modifier 59 or XS with documentation supporting distinct procedural services. NCCI edits apply — verify current edit status before billing.

04What global period applies, and what's bundled?

26550 carries a 90-day global period. Routine post-op visits, wound care, splint changes, and suture removal through day 90 are all bundled. Bill E/M services in the global window with modifier 24 only if unrelated to the thumb reconstruction.

05How do I bill if a co-surgeon is involved?

Append modifier 62 to both surgeons' claims when two surgeons of different specialties each perform distinct portions of the pollicization (e.g., hand surgeon and microvascular surgeon). Each surgeon documents their individual role in a separate operative note or clearly delineated section of a shared note.

06Is 26550 covered for congenital thumb absence in pediatric patients?

Yes, congenital thumb aplasia or hypoplasia is the primary indication. Confirm the diagnosis with the appropriate ICD-10 congenital anomaly code and document the functional deficit and failure of non-surgical management where applicable. Payer prior authorization is commonly required for pediatric reconstructive procedures of this magnitude.

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 donor digit identified, neurovascular pedicle handling, skeletal shortening and derotation performed, and tendon rebalancing steps from the surgeon's dictation — the exact elements auditors and payers check to confirm 26550 over a less complex transfer code. Missing any of these in the operative note is the primary trigger for downcoding to 26555 or an outright medical necessity denial.

See how Mira captures CPT 26550 documentation