Surgical reconstruction of a congenital cleft hand deformity involving absence of one or more central digits, resulting in a V-shaped central deficiency of the hand.

Verified May 8, 2026 · 7 sources ↓

Medicare: $1,447.93
Total RVUs: 43.35
Global, days: 90
Region: Hand

Drawn from CMSFastrvuAAPCMdclarityCgsmedicare

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Preoperative diagnosis with ICD-10 code specifying congenital cleft hand (Q71.6x series), including laterality
Operative note naming specific techniques performed: cleft closure, digital transposition, web space plasty, osseous procedures — not just 'cleft hand repair'
Documentation of which hand(s) were treated (left, right, or bilateral) to support laterality or bilateral modifiers
Description of the extent of the deformity, including number of rays absent and any associated anomalies such as syndactyly
For modifier 22: detailed narrative in the operative note quantifying the increased complexity, time, and work above the typical procedure
For staged procedures billed with modifier 58: prior operative note or clinical documentation establishing the staged plan at the time of the original surgery

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 50 Bilateral procedure 51 Multiple procedures 58 Staged or related 76 Repeat, same physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 26580 covers operative repair of cleft hand, a congenital anomaly where one or more central rays of the hand are absent, creating a V-shaped cleft in the palm. The procedure typically involves soft tissue rearrangement, web space reconstruction, digital transposition, and osseous realignment to restore hand function and close the central cleft. Complexity varies significantly based on the depth of the cleft, number of rays affected, and presence of syndactyly or other associated anomalies.

The 90-day global period means the surgery, any same-day pre-op visit, and all routine postoperative management through day 90 are bundled into 26580. Staged reconstruction planned at the time of the primary procedure requires modifier 58. An unplanned return to the OR for a related complication — such as wound dehiscence or flap failure — requires modifier 78. Unrelated procedures performed during the global period require modifier 79.

Cleft hand repair is performed almost exclusively in pediatric patients; if the patient weighs under 4 kg, standard modifier 63 rules apply for neonates, though its use is restricted to the surgical code series and must be justified in documentation. Because cleft hand is typically unilateral but can present bilaterally, laterality modifiers LT and RT are essential for clean claims; modifier 50 applies when both hands are reconstructed in the same operative session.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	19.26
Practice expense RVU	19.99
Malpractice RVU	4.1
Total RVU	43.35
Medicare national rate	$1,447.93
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	$1,447.93
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 26580 get rejected.

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

Missing or non-specific laterality — claims submitted without LT or RT modifier when payer requires it
ICD-10 diagnosis mismatch — using an acquired deformity code instead of the congenital cleft hand code (Q71.6x series)
Modifier 22 submitted without a supporting narrative in the operative note detailing the additional work performed
Global period violations — postoperative E/M or minor procedures billed without modifier 24 or 79 during the 90-day window
Modifier 78 applied to an unrelated return-to-OR procedure instead of the correct modifier 79

Frequently asked questions

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

01Can 26580 be billed bilaterally if both hands are repaired in the same session?

Yes. Append modifier 50 when cleft hand repair is performed on both hands in the same operative session. Bill on a single claim line. Do not append LT and RT separately on two lines when using modifier 50.

02What ICD-10 code supports 26580?

The primary diagnosis is congenital absence/reduction defect of hand — Q71.6x series, with the final character specifying laterality (Q71.60 unspecified, Q71.61 right, Q71.62 left, Q71.63 bilateral). Using an acquired deformity code is a common mismatch denial trigger.

03If a staged second procedure is planned after the index cleft hand repair, which modifier applies?

Modifier 58 applies when a subsequent procedure is staged or planned at the time of the original surgery and performed during the 90-day global period. Document the staged plan in the original operative note. Do not use modifier 78 — that is for unplanned returns for related complications only.

04When is modifier 22 appropriate for 26580?

Use modifier 22 when the complexity of the reconstruction significantly exceeds typical cleft hand repair — for example, a severe atypical cleft with multiple absent rays, extensive osseous realignment, or combined syndactyly release. The operative note must contain a specific narrative explaining the additional work; a generic statement is insufficient for audit.

05Is 26580 subject to NCCI bundling with adjacent tissue rearrangement or skin graft codes?

NCCI PTP edits can bundle component soft tissue procedures into 26580 when they are integral to the cleft repair. If a distinct, separately identifiable graft or flap was performed beyond what the cleft repair inherently includes, a modifier 59 or XS may allow separate payment — but verify the specific code pair using the CMS NCCI PTP lookup before submitting.

06Does the 90-day global period affect evaluation of syndactyly or other congenital anomalies on the same hand during the postoperative period?

If a separate, unrelated congenital anomaly is addressed surgically during the 90-day global period of 26580, use modifier 79. If it is a planned staged component of the overall reconstruction, use modifier 58. Modifier 24 applies only to E/M services that are unrelated to the original procedure.

Sources & references

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

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Mira's AI scribe captures the cleft hand deformity description, number of rays involved, operative techniques by name (cleft closure, digital transposition, web space plasty, osseous work), and hand laterality directly from dictation. This prevents the two most common 26580 denial drivers: a vague operative note that can't support modifier 22 when complexity is elevated, and missing laterality that triggers payer rejections before the claim reaches clinical review.

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