Surgical separation of congenitally fused fingers at a single web space, using local skin flaps and grafts to reconstruct the released web.
Verified May 8, 2026 · 5 sources ↓
- Medicare
- $946.25
- Total RVUs
- 28.33
- 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 which web space(s) was released (e.g., first, second, third web space) and laterality
- Name the flap design used — Z-plasty, rectangular dorsal flap, or other — not just 'skin flaps'
- Document graft type, harvest site, graft dimensions, and how the donor site was managed
- Confirm congenital vs. acquired etiology to support ICD-10 code selection
- Operative note must detail digit separation technique and extent of soft-tissue dissection
- Post-op plan for graft monitoring and splinting should appear in the operative or procedure note
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 26561 covers repair of syndactyly at one web space where the surgeon incises between the fused fingers, creates interdigitating skin flaps from the divided web, and supplements coverage with skin grafts. The flap design — most commonly Z-plasty or rectangular dorsal flaps — determines how much graft is needed and is a required documentation element. Each web space repaired is billed separately; bilateral or multi-web involvement requires modifiers and careful NCCI review.
The 90-day global period means all routine post-op visits, dressing changes, and graft-site wound care through day 90 are bundled. A same-day E/M for a separately identifiable pre-op issue needs modifier 25. Any unplanned return to the OR for a graft-related complication — dehiscence, partial loss — bills under modifier 78.
Congenital syndactyly is the expected diagnosis. ICD-10-CM Q70.1x (webbing of fingers) is the principal crosswalk; specificity to unilateral vs. bilateral and the digit pair involved is required by most payers. Acquired web contracture after burn or trauma maps to a different ICD-10 category and may shift payer coverage criteria, so confirm before submitting.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 10.82 |
| Practice expense RVU | 15.2 |
| Malpractice RVU | 2.31 |
| Total RVU | 28.33 |
| Medicare national rate | $946.25 |
| 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 | $946.25 |
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 26561 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Missing or non-specific ICD-10 code — payers require digit-level and laterality specificity for Q70.1x
- Billing multiple web-space repairs without separate line items or modifier 59 to unbundle
- Absence of graft documentation; payers audit for graft type and harvest site to confirm 26561 vs. a lesser code
- Routine post-op visits billed during the 90-day global without modifier 24 or 25
- Lack of medical necessity documentation when payer requires prior authorization for congenital repair in pediatric patients
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 5 cited references ↓
01Can I bill 26561 twice if I repair two web spaces in the same operative session?
02What is the difference between 26560 and 26561?
03How do I bill for bilateral syndactyly repair done in the same session?
04Does the 90-day global include graft-site wound care visits?
05What ICD-10 codes support 26561 for congenital syndactyly?
06Can 26561 be performed in an ASC, and does site of service affect payment?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
Mira AI Scribe
Mira's AI scribe captures web space number, laterality, flap design by name, graft type and dimensions, and donor-site closure from dictation — the exact elements auditors check to confirm 26561 over a simpler syndactyly release. That prevents downcoding denials that cite insufficient documentation of the graft component.
See how Mira captures CPT 26561 documentation