Toe-to-hand transfer with microvascular anastomosis, single digit other than the great toe
Verified May 8, 2026 · 5 sources ↓
- Medicare
- $2,954.98
- Total RVUs
- 88.47
- 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 5 cited references ↓
- Specify the donor toe harvested (e.g., second or third toe) and the recipient digit or ray being reconstructed
- Document microvascular anastomosis technique, including artery and vein identifications and patency confirmation
- Record the two-team approach if used, with each surgeon's distinct role for co-surgeon (modifier 62) billing purposes
- Document the indication — digit absence, amputation level, failed prior reconstruction, or congenital anomaly — with functional deficit described
- Include intraoperative flap perfusion assessment (Doppler signals, capillary refill, color) before wound closure
- Note tendon repairs, nerve coaptations, and bone fixation methods performed as part of the transfer
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 5 cited references ↓
CPT 26553 describes a single toe-to-hand free tissue transfer using microvascular anastomosis, performed with a donor digit other than the great toe. The procedure reconstructs a missing or non-functional finger — typically the thumb or index finger — by harvesting a lesser toe, anastomosing its vascular supply to recipient vessels in the hand, and establishing tendon and nerve continuity. It is one of the most technically demanding procedures in hand surgery, often requiring a two-team approach operating simultaneously at donor and recipient sites.
The 90-day global period covers all routine post-operative management through day 90, including flap monitoring visits, dressing changes, and suture removal. Any visit for an unrelated condition within that window requires modifier 24. A planned staged procedure in the global period — such as a secondary tenolysis or nerve repair — bills with modifier 58. An unplanned return to the OR for a complication related to the original transfer uses modifier 78; an unrelated OR procedure in the same window uses modifier 79.
The procedure maps to APC 5114 in the hospital outpatient setting (J1 status indicator), as confirmed in AAOS 2021 OPPS tables. Payers vary on prior authorization requirements and medical necessity criteria for toe-to-hand transfers; document digit absence or non-viability, failure or unsuitability of alternative reconstructions, and functional impact explicitly in the operative report and clinical notes.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 46.97 |
| Practice expense RVU | 31.45 |
| Malpractice RVU | 10.05 |
| Total RVU | 88.47 |
| Medicare national rate | $2,954.98 |
| 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 | $2,954.98 |
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 26553 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Missing or insufficient medical necessity documentation — no explicit statement of digit loss, functional impact, or why simpler reconstruction was not appropriate
- Co-surgeon modifier 62 denied because operative notes don't clearly delineate each surgeon's distinct intraoperative role
- Global period billing conflict — post-op visits billed without modifier 24 when payer determines they fall within the 90-day global
- Prior authorization not obtained or obtained for wrong procedure code before a highly complex reconstruction
- Modifier 22 claim for increased procedural complexity rejected due to lack of quantified additional time and specific complicating factors in the operative note
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 5 cited references ↓
01Can two surgeons each bill 26553 with modifier 62?
02How does 26553 differ from 26551?
03What modifier applies if the patient returns to the OR within 90 days because the flap fails and requires revision?
04Is modifier 22 supportable for 26553?
05Does the 90-day global period apply in all settings?
06What diagnosis codes best support medical necessity for 26553?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02aaos.orghttps://www.aaos.org/globalassets/advocacy/issues/2021-opps-pr-tables.pdf
- 03cms.govhttps://www.cms.gov/medicare/coding-billing/national-correct-coding-initiative-ncci-edits
- 04cms.govhttps://www.cms.gov/files/document/2025nccimedicarepolicymanualcompletepdf.pdf
- 05mdclarity.comhttps://www.mdclarity.com/cpt-code/26553
Mira AI Scribe
Mira's AI scribe captures donor site (specific toe harvested), recipient site (digit or ray reconstructed), microvascular anastomosis details, nerve and tendon repair performed, bone fixation method, and intraoperative perfusion confirmation from dictation. This prevents the most common denial trigger for 26553: an operative note that documents the harvest and inset but omits anastomosis patency confirmation and individual surgical team roles needed to support modifier 62.
See how Mira captures CPT 26553 documentation