Surgical repositioning of a finger or thumb displaced due to polydactyly, where duplicate digit tissue is removed and the remaining finger is placed in a functionally appropriate anatomic position.

Verified May 8, 2026 · 6 sources ↓

Medicare: $1,308.98
Total RVUs: 39.19
Global, days: 90
Region: Hand

Drawn from CMSAAPCAAOSBedrockbillingCgsmedicare

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Diagnosis of polydactyly with laterality specified (ICD-10 Q69.x) and the digit(s) involved
Operative note naming the specific digit repositioned and the supernumerary digit excised
Description of osseous and soft-tissue maneuvers performed to achieve anatomic positioning
Preoperative imaging or clinical photographs documenting the malposition and extra digit anatomy
If modifier 22 is appended, documentation of what made the work substantially greater than typical — altered anatomy, prior scarring, complexity of bone remodeling
If staged procedure is planned, document that intent explicitly in the initial operative note before appending modifier 58 to a subsequent claim

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 24 Unrelated E/M during global 25 Significant separate E/M 50 Bilateral procedure 51 Multiple procedures 57 Decision for surgery 58 Staged or related 59 Distinct service 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 26555 covers the surgical correction of a malpositioned finger or thumb in the setting of polydactyly — the congenital presence of one or more extra digits. The surgeon excises the supernumerary finger and repositions the retained digit to restore proper anatomic alignment and function. This is a reconstructive hand procedure, not a simple soft-tissue excision; the work involves osseous and soft-tissue management to achieve stable, functional positioning.

The 90-day global period applies. That means the day-before visit, the operative day, and all routine postoperative care through day 90 are bundled. If you're billing an E/M during that window for an unrelated condition, append modifier 24. If the decision for this surgery was made at a same-day or day-before E/M visit, append modifier 57 to that E/M — modifier 57 applies because this is a 90-day global procedure.

Site of service matters significantly here. The HOPD and ASC payment rates differ substantially (see the Site of Service comparison table). For bilateral polydactyly corrections performed in the same operative session, modifier 50 applies. If you're performing staged additional reconstruction within the global period — for example, subsequent tendon or bone work — use modifier 58 and document the staged intent in the original operative note.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	16.65
Practice expense RVU	18.99
Malpractice RVU	3.55
Total RVU	39.19
Medicare national rate	$1,308.98
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	$1,308.98
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI A2) Ambulatory surgical center (freestanding)	$3,695.53

Common denial reasons

The recurring reasons claims for CPT 26555 get rejected.

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

Missing or nonspecific ICD-10 code — polydactyly type and laterality must be coded to highest specificity
Operative note uses vague language like 'extra digit removed' without documenting the repositioning work that distinguishes 26555 from a simple digit amputation code
Bilateral procedures billed without modifier 50 or individual LT/RT modifiers, triggering duplicate claim edits
E/M billed on the same day as surgery without modifier 25 (if pre-op decision visit) or modifier 57 (if decision for this 90-day global surgery was made at that visit)
Unbundling of wound closure or tendon repair components that are inherent to the repositioning and not separately reportable under NCCI edits

Frequently asked questions

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

01Can 26555 be billed bilaterally if both hands are corrected in the same session?

Yes. Append modifier 50 for a bilateral procedure billed on a single line, or use LT and RT on separate lines depending on payer preference. Confirm with the specific payer — some commercial plans require separate line items over the modifier 50 convention.

02What modifier applies if the surgeon returns to the OR during the 90-day global for related additional reconstruction?

Modifier 58 applies if the return was planned and staged — document the intent in the original operative note. Modifier 78 applies if the return was unplanned and related to the original procedure (e.g., a complication requiring further operative management). Do not use 79, which is for unrelated procedures.

03Is modifier 57 needed if the decision for surgery was made at an office visit the day of or day before 26555?

Yes. Because 26555 carries a 90-day global, modifier 57 must be appended to the E/M code when the surgical decision was made at that visit. Modifier 57 is required for 90-day global procedures; modifier 25 is used for minor procedures with 0- or 10-day globals.

04What ICD-10 codes pair with 26555?

Polydactyly codes in the Q69.x range are the primary diagnoses. Code to the highest specificity available — extra finger (Q69.0), extra thumb (Q69.1), or other polydactyly (Q69.9). Payers match the diagnosis to the procedure; a nonspecific or mismatched code is a leading denial trigger for this code.

05Is 26555 distinct from amputation codes for extra digits?

Yes, and the distinction matters for coding and medical necessity. 26555 requires documented repositioning of the retained digit, not just excision of the extra one. If the operative note only describes removal without repositioning work, auditors will question whether the correct code was selected.

06Does the site of service affect payment for 26555?

Significantly. HOPD and ASC payment rates differ materially — see the Site of Service comparison table on this page. For elective pediatric polydactyly correction, ASC is the more common setting and carries a lower facility payment than HOPD.

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 specific digit repositioned, the supernumerary digit excised, the osseous and soft-tissue steps taken to achieve anatomic alignment, and the laterality — all from dictation. This prevents the most common audit flag for 26555: operative notes that document only excision without the repositioning work that justifies this code over a simpler amputation or excision code.

See how Mira captures CPT 26555 documentation