Surgical lengthening of a metacarpal or phalanx bone, typically performed via osteodistraction — the controlled separation of two bone segments to allow new bone formation in the gap.

Verified May 8, 2026 · 7 sources ↓

Medicare: $911.18
Total RVUs: 27.28
Global, days: 90
Region: Hand

Drawn from CMSAAPCMdclarityEatonhandAAOS

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 bone is lengthened — metacarpal number or phalanx level (proximal, middle, distal) and digit number
Document the indication: congenital shortening, post-traumatic defect, or other diagnosis with supporting imaging
Describe the osteotomy technique and the distraction device used (type, placement, activation protocol)
Record the targeted lengthening distance and intraoperative findings including bone quality
Note laterality (left vs. right hand) and whether the procedure is staged or single-session
Include preoperative imaging (X-ray or CT) confirming bone shortening and post-op imaging confirming device placement

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 52 Reduced services 57 Decision for surgery 58 Staged or related 62 Co-surgeons 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 26568 covers operative lengthening of a metacarpal or finger phalanx. The standard technique is osteodistraction (callotasis): the bone is osteotomized, a distraction device is applied, and the segments are incrementally separated over weeks so regenerate bone fills the gap. Indications include congenital brachydactyly, post-traumatic shortening, and acquired bony defects where length restoration is functionally or anatomically necessary.

This carries a 90-day global period. All routine post-op visits, device adjustments integral to the distraction protocol, and hardware checks fall inside the global. If a complication requiring a separate return to the OR arises — planned or unplanned — use modifier 78 (unplanned, related) or 79 (unrelated) accordingly. A new and significant problem presenting during the global that warrants a distinct E/M service needs modifier 24.

Site of service matters here: HOPD and ASC payments differ substantially — see the Site of Service comparison table on this page. When the procedure is performed on a single digit, append LT or RT. If bilateral lengthening is performed in the same session (uncommon but possible), modifier 50 applies with a single line. If a co-surgeon assists in a technically complex reconstruction, modifier 62 or 80 may be appropriate depending on each surgeon's distinct role.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	9.04
Practice expense RVU	16.32
Malpractice RVU	1.92
Total RVU	27.28
Medicare national rate	$911.18
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	$911.18
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$5,165.80

Common denial reasons

The recurring reasons claims for CPT 26568 get rejected.

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

Missing or vague laterality — claim lacks LT/RT modifier when payer requires it for unilateral digit procedures
Diagnosis mismatch — ICD-10 code does not support medical necessity for surgical lengthening (e.g., cosmetic-only framing without functional impairment documented)
Global period conflict — post-op visit billed without modifier 24 or 25 during the 90-day global
Insufficient operative note detail — note does not specify osteotomy technique or distraction device, triggering medical necessity audit
Bundling conflict — separately billing a bone graft harvest or fixation device application that is considered integral to the lengthening procedure by the payer

Frequently asked questions

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

01Does 26568 have a global period, and what does it cover?

Yes — 90-day global. It covers the surgery, the day-before pre-op visit, and all routine post-op management through day 90, including distraction device adjustments that are part of the planned lengthening protocol. Unrelated E/M visits during that window need modifier 24.

02Can I bill separately for distraction device application or removal?

Device application integral to the osteodistraction technique is bundled into 26568. Staged hardware removal after the global period closes may be separately reportable — confirm with your payer's bundling policy and the AAOS Complete Global Service Data.

03When is modifier 22 appropriate for this code?

Use modifier 22 when the procedure is substantially more work than typical — for example, revision lengthening through a prior surgical field, severe scarring, or an unusually complex distraction construct. Document increased time and complexity explicitly in the operative note; payers will request records.

04How do I bill if the same surgeon lengthens two metacarpals on the same hand in one session?

Bill 26568 as the primary code, then 26568-51 for the additional bone. List the higher-RVU service first. Confirm the second unit isn't subject to a Medically Unlikely Edit (MUE) restriction before submitting.

05What ICD-10 codes most reliably support medical necessity for 26568?

Congenital brachydactyly (Q71.8x, Q72.8x range), acquired shortening from prior fracture malunion (M21.2x series), or post-traumatic bone loss. The diagnosis must reflect functional impairment — payers routinely deny claims where documentation reads as cosmetic.

06Is there a difference in reimbursement between HOPD and ASC settings for this code?

Yes — HOPD and ASC facility payments differ materially. See the Site of Service comparison table on this page for current 2026 values. That gap can affect where you schedule the case, especially for patients with high cost-sharing.

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 bone lengthened (metacarpal number or phalanx level and digit), the osteotomy approach, distraction device type and activation plan, targeted lengthening distance, laterality, and primary diagnosis from dictation. That detail prevents the two most common denials for 26568: vague operative notes triggering medical necessity reviews and laterality omissions that bounce claims at the clearinghouse.

See how Mira captures CPT 26568 documentation