Surgical reconstruction of a polydactylous (extra) digit of the hand, involving excision and remodeling of both soft tissue and bone.

Verified May 8, 2026 · 6 sources ↓

Medicare: $971.30
Total RVUs: 29.08
Global, days: 90
Region: Hand

Drawn from CMSAAPCKzanowWorkerscomp

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Explicit documentation that bone was present and addressed — phalanx, metacarpal, osteotomy, or bony excision — to distinguish 26587 from 11200
Operative note must identify the specific digit(s) reconstructed (e.g., radial vs. ulnar duplicate, thumb vs. small finger polydactyly)
Laterality clearly stated (right vs. left hand) to support RT/LT modifier and prevent claim mismatch
Description of soft tissue reconstruction performed alongside bony work — skin flap design, ligament repair, or tendon rebalancing as applicable
Preoperative diagnosis including ICD-10 polydactyly code (Q69.x series) correlated to operative findings
If bilateral same-session procedure, document both hands separately in the operative note with independent findings for each side

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 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side 58 Staged or related

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 26587 covers reconstruction of an extra finger (polydactyly) where the surgeon removes or remodels the supernumerary digit including its bony component. The bone involvement is what separates 26587 from soft-tissue-only removal — if no bone is excised or reconstructed, 26587 does not apply. Cases where the extra digit is purely soft tissue route to 11200 (skin tag/fibrocutaneous tag removal), per the parenthetical guidance in the CPT hand section.

Polydactyly reconstruction typically requires stabilization or recontouring of the remaining digit, ligament balancing, and sometimes osteotomy or bony fixation to restore alignment and function. The operative note must clearly document bony work — presence of a phalanx, metacarpal involvement, osteotomy, or bone excision — to support 26587 over the lower-valued alternative. Payers audit this distinction specifically.

The code carries a 90-day global period. Routine post-op visits, wound checks, and suture removal through day 90 are bundled. Separate E/M encounters during that window require modifier 24 (unrelated) or 25 (significant, separately identifiable on the same day as a procedure). Staged reconstruction of additional digits on the same hand requires modifier 58 if planned, or 78 if unplanned and related.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	14.14
Practice expense RVU	11.93
Malpractice RVU	3.01
Total RVU	29.08
Medicare national rate	$971.30
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	$971.30
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 26587 get rejected.

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

26587 billed when operative note documents soft tissue only — payer downcodes or denies in favor of 11200
Missing laterality: claim submitted without RT or LT modifier triggers edit flags at many MACs and commercial payers
ICD-10 diagnosis mismatch — billing Q69.x (polydactyly) against a note that only describes excision of a skin tag or accessory digit without bony detail
Unbundling errors when same-session procedures on adjacent digits are billed without modifier 51 or 59 to establish distinct service
Post-op E/M billed within the 90-day global period without modifier 24, causing automatic bundling denial

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01What's the difference between billing 26587 and 11200 for polydactyly?

26587 requires both soft tissue and bone to be excised or reconstructed. If the extra digit is purely soft tissue with no bony component involved, the CPT parenthetical note directs you to 11200 instead. Audit teams check this distinction directly against the operative note.

02Can 26587 be billed bilaterally in the same session?

Yes. Use modifier 50 for bilateral same-session polydactyly reconstruction, or bill two line items with LT and RT. Confirm your payer's preference — some MACs require 50 on a single line; some commercial payers want two lines. Document independent findings for each hand in the operative note.

03What global period applies to 26587, and what does it include?

26587 carries a 90-day global. The day-before visit, the day of surgery, and all routine post-op care through day 90 are bundled. Separate E/M visits during that window need modifier 24 if unrelated to the hand reconstruction or modifier 25 if on the same day as another procedure.

04If a staged second surgery is needed on the same hand during the global period, what modifier applies?

Modifier 58 applies if the second procedure was planned or staged — for example, correcting a second duplicate digit identified at the time of the original surgery. Use modifier 78 only if the return to the OR was unplanned and related to a complication of the original reconstruction.

05Does modifier 22 ever apply to 26587?

Yes, when the reconstruction is substantially more complex than typical — for instance, severe angular deformity requiring osteotomy and internal fixation, or complex ligament reconstruction to prevent post-excision instability. Document total operative time, complexity of bony work, and what made the case exceed the standard procedure.

06Which ICD-10 codes pair with 26587?

The Q69.x series covers congenital polydactyly — Q69.0 (accessory finger), Q69.1 (accessory thumb), Q69.9 (unspecified). Use the most specific code matching the operative site. Acquired or post-traumatic extra digit presentations are rare; document the etiology clearly if not congenital.

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 key 26587 gate-keeper detail from dictation: whether the surgeon excised or reconstructed bone alongside soft tissue. It flags operative notes that describe digit removal without explicit bony involvement and prompts the surgeon to confirm — preventing the most common downcode to 11200. It also auto-populates laterality (RT/LT) from the dictated site, eliminating a leading modifier-omission denial.

See how Mira captures CPT 26587 documentation