Surgical separation and reconstruction of congenitally fused fingers involving complex repair with bone work, nail bed release, and nail fold reconstruction.

Verified May 8, 2026 · 7 sources ↓

Medicare: $1,309.65
Total RVUs: 39.21
Global, days: 90
Region: Hand

Drawn from CMSAAPCMdclarityCgsmedicareEatonhand

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Specify which web space(s) were repaired and identify the fingers involved (e.g., long-ring web space, right hand)
Document bone involvement explicitly — osteotomy performed, bone excised, or fused phalanx addressed — to justify the complex code level over 26560 or 26561
Record nail bed release and nail fold reconstruction technique if performed; absence of this documentation weakens the complex designation
Note skin graft type (full-thickness vs. split-thickness), donor site, and dimensions — grafting is bundled into 26562 and must appear in the operative note
Confirm congenital diagnosis in the medical record with ICD-10 coding consistent with syndactyly (Q70.x range)
Laterality must be specified (left, right, or bilateral) for modifier selection and claim accuracy

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 51 Multiple procedures 59 Distinct service 76 Repeat, same physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 26562 covers complex syndactyly repair — specifically the separation of webbed fingers where the fusion involves bone (osteotomy or excision) and fused nail beds requiring nail fold reconstruction. This distinguishes it from simpler syndactyly releases: the complexity threshold is bone involvement and/or nail apparatus reconstruction, not just soft-tissue division.

Skin grafts are included in the code. The operative note should document that grafting was performed to close the resulting wound — billing a separate skin graft code alongside 26562 will trigger a bundling conflict. If the graft site requires significant additional work well beyond the typical closure, modifier 22 with supporting documentation is the route, not an unbundled graft code.

The 90-day global period applies. Any hand therapy referrals, splinting, or routine post-op visits through day 90 are bundled. New, unrelated hand problems presenting in that window need modifier 24 on the E/M or modifier 79 on any unrelated surgical procedure.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	16.26
Practice expense RVU	19.49
Malpractice RVU	3.46
Total RVU	39.21
Medicare national rate	$1,309.65
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	$1,309.65
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 26562 get rejected.

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

Unbundled skin graft code billed alongside 26562 — grafting is included in the procedure; separate graft codes will deny under NCCI bundling
Wrong complexity level selected — 26560 (simple) or 26561 (moderately complex) billed when bone involvement documented, or 26562 billed without supporting documentation of bone or nail reconstruction
Missing or vague laterality — claims without LT/RT modifier or with conflicting laterality between the claim and operative note
Diagnosis mismatch — ICD-10 code does not reflect congenital syndactyly (e.g., Q70.x); acquired conditions or trauma-based fusions require different diagnosis coding and may trigger medical necessity review
Routine post-op services billed separately within the 90-day global period without modifier 24 or 79

Frequently asked questions

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

01What separates 26562 from 26560 and 26561?

26560 is simple syndactyly repair (skin and soft tissue only). 26561 is moderately complex. 26562 requires bone work — osteotomy or bone excision — and/or nail bed release with nail fold reconstruction. If your operative note doesn't document bone involvement or nail apparatus work, you can't defensibly bill 26562.

02Is the skin graft separately billable with 26562?

No. Skin grafting used to close the wound after syndactyly separation is bundled into 26562. Billing a separate graft code will trigger an NCCI edit. If the graft work was substantially beyond the norm, append modifier 22 with a written justification — don't unbundle.

03Can I bill 26562 for multiple web spaces in the same operative session?

Yes. Each web space repaired is a separate unit. Bill 26562 for the primary web space, then apply modifier 51 to additional web spaces repaired in the same session. Confirm each web space has its own documentation in the operative note.

04Which ICD-10 codes support 26562?

Syndactyly codes fall in the Q70.x range. Select the specific code reflecting the type (with or without fusion of bone) and laterality. Using a non-congenital or trauma diagnosis code mismatches the procedure and invites medical necessity denial.

05How does the 90-day global affect post-op hand therapy and splinting orders?

The global period bundles all routine post-op care through day 90. Splint application, dressing changes, and routine follow-up visits are not separately billable. Hand therapy services by a different provider (OT/PT) are not subject to the surgeon's global period and bill independently. If a new, unrelated problem is addressed in the post-op window, the E/M needs modifier 24.

06When do I use modifier 78 versus 79 for a return to the OR during the global period?

Modifier 78 applies when the patient returns to the OR for a complication or related issue from the original syndactyly repair — for example, wound dehiscence or flap failure. Modifier 79 applies when the return is for a completely unrelated procedure. Inverting these modifiers is a common audit finding.

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 location, finger pair involved, laterality, bone work performed (osteotomy type or excision detail), nail bed and nail fold reconstruction technique, and skin graft specifics (type, donor site, dimensions) directly from operative dictation. This prevents the two most common audit flags for 26562: operative notes that lack explicit bone-involvement language needed to defend the complex code level, and missing graft documentation that auditors use to challenge whether a separately billed graft was appropriate.

See how Mira captures CPT 26562 documentation