Surgical separation of congenitally fused fingers in a single web space, using skin flaps created during the division to repair the wound.

Verified May 8, 2026 · 7 sources ↓

Medicare: $637.96
Work RVU: 5.38
Global, days: 90
Region: Hand

Drawn from CMSAAPCFindacodeEmednyBedrockbilling

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Specify the exact web space(s) treated (e.g., index-long, ring-small) and laterality in the operative note.
Document the flap design and technique — auditors flag notes that say only 'skin flaps raised and closed' without anatomic detail.
Confirm congenital syndactyly diagnosis with ICD-10 code (Q70.xx); specificity to digit and laterality is required.
If staging multiple web spaces, document the surgical plan for each stage to support modifier 58 use at the subsequent encounter.
Record intraoperative findings including extent of soft-tissue fusion, presence or absence of bony union, and nail involvement — findings that distinguish 26560 from 26561 or 26562.
Preoperative photos and functional assessment support medical necessity, especially for commercial payers requiring prior authorization.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

50 Bilateral procedure 51 Multiple procedures 58 Staged or related 59 Distinct service 62 Co-surgeons LT Left side RT Right side 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon 22 Increased complexity 52 Reduced services

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

26560 covers the surgical release of syndactyly — congenitally joined fingers — at one web space, using local skin flaps raised during the division to reconstruct the interdigital commissure. The descriptor specifies skin flaps only; if a skin graft is also required, bill 26561 instead. For complex cases involving bone or nail involvement, 26562 applies. Each web space released is a separate reportable event, so multiple web spaces on the same hand or bilateral involvement each require appropriate unit or modifier reporting.

The 90-day global period covers all routine postoperative management through day 90, including dressing changes and suture removal. Staged procedures for additional web spaces performed after the global clears are billed with modifier 58 if planned, or 79 if unrelated to the original repair. Wound closure complications requiring unplanned return in the global window use modifier 78.

Site of service matters here. HOPD and ASC payments differ substantially; see the Site of Service comparison on this page. Most pediatric syndactyly repairs land in a hospital outpatient or ASC setting. Payer prior-authorization requirements for congenital hand procedures vary — commercial plans frequently require functional impairment documentation before approving surgical correction.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU vs. total RVU

The work RVU (5.38) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (19.1) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	5.38
Practice expense RVU	12.57
Malpractice RVU	1.15
Total RVU	19.1
Medicare national rate	$637.96
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	$637.96
HOPD (APC 5112) Hospital outpatient department	$1,642.82
ASC (PI A2) Ambulatory surgical center (freestanding)	$872.87

Common denial reasons

The recurring reasons claims for CPT 26560 get rejected.

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

Wrong code selected — 26561 or 26562 required if graft or bone/nail involvement is present; 26560 denied when operative note documents graft use.
Missing or non-specific laterality and digit documentation causes claim rejection or requests for additional documentation.
Global period conflict when a subsequent web space repair is billed without modifier 58 (planned staged) within the 90-day window of the first procedure.
Lack of prior authorization from commercial payers for congenital hand reconstruction; syndactyly repair is frequently subject to PA requirements.
ICD-10 specificity mismatch — billing a non-specific Q70 code when the payer requires digit-level and laterality specificity.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01When should I use 26561 or 26562 instead of 26560?

Use 26561 when the repair requires both skin flaps and a skin graft. Use 26562 for complex syndactyly involving bone or nail structures. If the operative note documents graft harvest or bony fusion release, 26560 will be denied — it covers skin flap repair only.

02Can I bill 26560 twice if I release two web spaces on the same hand in one session?

Yes. The descriptor states 'each web space,' so each additional space released is billable. Report 26560 for the primary web space, then 26560 with modifier 51 for each additional web space on the same hand during the same session.

03How do I bill for bilateral syndactyly repair in the same operative session?

Report 26560 with modifier 50 for bilateral repair performed in the same session, or use LT and RT on separate lines depending on payer preference. Confirm with the specific payer — some commercial plans require separate line items with LT/RT rather than modifier 50.

04What modifier applies if I repair a second web space on the same hand 6 weeks after the first, as part of a staged plan?

Use modifier 58 — staged or related procedure by the same physician during the postoperative period. The 90-day global from the first repair is still active at week 6, so billing without a modifier will deny. Document the staged plan in both the original and subsequent operative notes.

05Does 26560 require prior authorization for pediatric patients on commercial insurance?

Frequently yes. Many commercial payers classify congenital hand reconstruction as requiring preauthorization and may request documentation of functional impairment, not just cosmetic concern. Obtain PA before scheduling when possible and retain the authorization number for the claim.

06What ICD-10 codes typically pair with 26560?

Syndactyly codes fall under Q70. Use Q70.0x for fused fingers and Q70.1x for webbed fingers, with the fifth character specifying right hand, left hand, or bilateral. Non-specific Q70.9 may trigger requests for additional documentation from payers requiring digit-level specificity.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira Scribe

Mira's AI scribe captures the specific web space released (e.g., second web space, right hand), flap design, wound closure technique, and confirms absence of bone or nail involvement from the dictation — the details that distinguish 26560 from 26561 or 26562. That prevents downcoding or upcoding flags during audit and supports the laterality and digit specificity that commercial payers require for prior authorization and clean claim adjudication.

See how Mira captures CPT 26560 documentation