Osteotomy of a single metacarpal bone to correct deformity, malunion, or abnormal alignment in the hand.

Verified May 8, 2026 · 7 sources ↓

Medicare: $690.40
Total RVUs: 20.67
Global, days: 90
Region: Hand

Drawn from CMSAAPCGenhealthEatonhandAAOS

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Identify the specific metacarpal(s) by number (e.g., third metacarpal) and hand laterality.
State the indication explicitly — malunion, rotational deformity, congenital deformity, or other structural abnormality.
Describe the osteotomy technique: type of bone cut, instruments used, and how realignment was achieved.
Document internal fixation method — plates, screws, K-wires, or other hardware — with implant details.
Record pre-op imaging (X-ray or CT) that confirmed the deformity and guided surgical planning.
Note anesthesia type (general vs. regional block) and any tourniquet use and time.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 52 Reduced services 59 Distinct service LT Left side RT Right side 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 26565 covers a metacarpal osteotomy — the surgeon cuts and repositions one metacarpal bone to restore proper alignment, correct a rotational deformity, or address a malunion. Internal fixation with plates, screws, or pins typically follows the bone cut, and the code is reported per bone operated on. The 90-day global period means post-op hand therapy referrals, routine wound checks, and implant-related follow-up visits are all bundled through day 90.

Code selection is the most common coding pitfall here. 26565 is the right choice when the operative goal is deformity correction via osteotomy. If the surgeon is addressing a true fracture malunion with ORIF, some coders and payers argue 26546 (repair of malunion) or 26615 (ORIF metacarpal fracture) with modifier 22 better reflects the work — check your payer's position and get that operative report to clearly document whether an osteotomy was the primary technique. When multiple metacarpals are cut in the same hand during the same session, report 26565 for each bone, with modifier 51 on the secondary procedures.

Plastic and reconstructive surgery leads utilization by specialty. The procedure runs in both hospital outpatient and ASC settings; site-of-service differential is significant — see the Site of Service comparison table on this page.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	6.74
Practice expense RVU	12.62
Malpractice RVU	1.31
Total RVU	20.67
Medicare national rate	$690.40
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	$690.40
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 26565 get rejected.

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

Code mismatch: payer flags 26565 when operative note describes ORIF of a malunion fracture, expecting 26546 or 26615 instead.
Missing laterality modifier (LT or RT) causing claim rejection on bilateral-edit payers.
Unbundling denial when multiple metacarpal osteotomies are billed without modifier 51 on secondary bones.
Insufficient documentation — operative note says 'standard osteotomy' without naming the specific metacarpal or describing the corrective technique.
Global period conflict when a related post-op procedure is billed within the 90-day window without modifier 78 or 79.

Frequently asked questions

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

01Is 26565 the right code for a metacarpal malunion repair?

It depends on technique. If the surgeon performed an osteotomy to correct the malunion, 26565 applies. If the work was ORIF of the malunion fracture site, 26546 or 26615 with modifier 22 is more defensible. The operative note has to make the primary technique unambiguous.

02Can I bill 26565 more than once if two metacarpals are cut in the same session?

Yes. The code descriptor says 'each,' so bill one unit per metacarpal osteotomy. List the highest-RVU procedure first, append modifier 51 to the secondary code, and document each bone distinctly in the operative note.

03What modifier do I use for a left-hand metacarpal osteotomy?

Append modifier LT. Most commercial payers and Medicare require laterality on hand and finger procedures. Missing it is a common clean-claim failure.

04If the patient returns within 90 days for hardware removal from the same metacarpal, what modifier applies?

Modifier 78 — unplanned return to the OR for a procedure related to the original surgery during the global period. If the hardware removal is for a different, unrelated reason, use modifier 79.

05Can 26565 and 26615 be billed together for the same bone?

Generally no. NCCI edits bundle fracture fixation and osteotomy procedures performed on the same bone in the same session. If both were genuinely distinct and necessary, modifier 59 or XS would need strong operative note support — but this scenario is unusual and audit-prone.

06Is modifier 22 ever appropriate with 26565?

Yes, when the osteotomy required substantially greater work than typical — for example, severe deformity requiring complex realignment, significant additional operative time, or unusual technical difficulty. Document the specific factors that increased complexity; modifier 22 without that narrative will be denied.

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 metacarpal number, the deformity type and its pre-op imaging confirmation, the osteotomy technique, and the fixation construct from dictation. That level of specificity prevents the most common audit flag on 26565 — an operative note that doesn't distinguish a corrective osteotomy from a fracture ORIF, which is what payers use to downcode or reroute to 26546 or 26615.

See how Mira captures CPT 26565 documentation