Great-toe wrap-around transfer to the hand with microvascular anastomosis and bone graft for thumb reconstruction
Verified May 8, 2026 · 7 sources ↓
- Medicare
- $2,975.35
- Total RVUs
- 89.08
- 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 7 cited references ↓
- Indication for reconstruction: document mechanism of thumb loss (traumatic amputation, congenital absence, tumor resection) and level of deficit
- Donor site description: confirm great toe harvest with wrap-around skin flap technique and bone graft harvest specifics
- Microvascular anastomosis: identify recipient and donor vessels anastomosed, technique used, and confirmed patency at closure
- Tendon and nerve coaptation: name each structure repaired or connected at the recipient site
- Intraoperative Doppler or flow assessment confirming flap perfusion before wound closure
- Separate consent documentation for both the hand reconstruction and the foot donor site procedure
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 7 cited references ↓
CPT 26551 describes a toe-to-hand transfer in which the surgeon harvests the great toe — including its skin envelope, neurovascular bundle, tendons, and associated bone graft — and transplants it to reconstruct an absent or unsalvageable thumb. The procedure requires microvascular anastomosis to restore arterial inflow and venous outflow at the recipient site. It is most commonly performed for traumatic thumb loss or congenital thumb absence where the great toe's size and shape provide the best functional and aesthetic match.
This is a high-complexity microvascular procedure carrying a 90-day global period. All routine post-operative management of both the donor foot and the recipient hand falls within that global window. Unrelated problems treated during the global period require modifier 24; a separately identifiable E/M on the day of surgery requires modifier 25.
Code 26553 covers a non-great-toe single transfer; 26554 covers a double non-great-toe transfer. Do not report 69990 (operating microscope) separately — it is bundled under NCCI policy when microvascular anastomosis is integral to the procedure. Confirm current NCCI PTP edits before billing adjunct codes on the same date.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 47.27 |
| Practice expense RVU | 31.71 |
| Malpractice RVU | 10.1 |
| Total RVU | 89.08 |
| Medicare national rate | $2,975.35 |
| 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 | $2,975.35 |
HOPD (APC 5114) Hospital outpatient department | $7,413.38 |
ASC (PI J8) Ambulatory surgical center (freestanding) | $4,682.29 |
Common denial reasons
The recurring reasons claims for CPT 26551 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Missing or inadequate documentation of microvascular anastomosis — payers require vessel-level detail, not just 'microsurgical technique'
- Operative note describes only one anatomical site (hand) without a complete account of great-toe harvest at the donor foot
- Unbundling denial when 69990 (operating microscope) is billed separately on the same claim
- Medical necessity not established — absence of imaging, prior treatment records, or clear documentation of thumb loss etiology
- Wrong laterality modifier or omitted laterality modifier causing adjudication mismatch
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 7 cited references ↓
01Can 26551 and 26553 be billed together on the same hand?
02Is 69990 separately billable with 26551?
03What modifier is needed for a second surgery on the same thumb during the 90-day global?
04How should the foot donor site be coded?
05Does 26551 require prior authorization, and what documentation supports it?
06When is modifier 22 appropriate for 26551?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02mdclarity.comhttps://www.mdclarity.com/cpt-code/26551
- 03cms.govhttps://www.cms.gov/medicare/coding-billing/national-correct-coding-initiative-ncci-edits/medicare-ncci-faq-library
- 04emedny.orghttps://www.emedny.org/providermanuals/physician/pdfs/physician%20procedure%20codes%20sect5.pdf
- 05aapc.comhttps://www.aapc.com/codes/cpt-codes/26551
- 06eatonhand.comhttp://www.eatonhand.com/coding/n26551.htm
- 07aaos.orghttps://www.aaos.org/quality/coding-and-reimbursement/
Mira AI Scribe
Mira's AI scribe captures the great-toe harvest technique (wrap-around flap with bone graft), the specific vessels and nerves anastomosed or coapted, confirmed intraoperative perfusion, and the functional deficit that indicated reconstruction. That documentation prevents the most common denial: an operative note that mentions microvascular work without naming the anastomosed structures or establishing why the great toe — rather than a lesser-toe or prosthetic option — was selected.
See how Mira captures CPT 26551 documentation