Surgical correction of macrodactyly — abnormal enlargement of one or more fingers — involving reduction and reconstruction of the affected digit(s).
Verified May 8, 2026 · 4 sources ↓
- Medicare
- $1,339.71
- Total RVUs
- 40.11
- Global, days
- 90
- Region
- Hand
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 4 cited references ↓
- Specify which digit(s) are affected and the degree of macrodactyly (static vs. progressive type).
- Describe all tissue components addressed — bone, fat, nerve, skin — and the techniques used for each.
- Document preoperative imaging or clinical measurements confirming the degree of digital enlargement.
- Note whether this is a staged procedure in a planned series; if so, reference the prior operative note.
- Record neurovascular status of the digit pre- and intraoperatively, especially if nerve dissection was performed.
- Confirm ICD-10 diagnosis code aligns with the operative findings (e.g., congenital macrodactyly vs. acquired).
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 4 cited references ↓
CPT 26590 covers operative repair of macrodactyly, a congenital or acquired condition where one or more fingers are disproportionately enlarged due to overgrowth of bone, soft tissue, or both. The procedure typically involves debulking of soft tissue, osseous reduction or epiphysiodesis, and may include neurovascular dissection to address the underlying lipomatous or nerve-territory overgrowth driving the deformity. The extent of reconstruction varies significantly by digit involved, degree of enlargement, and patient age — factors that should be clearly captured in the operative note.
With a 90-day global period, all routine follow-up through day 90 is bundled. Staged procedures on the same digit — common in macrodactyly management since full correction often requires multiple sessions — require modifier 58 if planned and modifier 78 if the return to the OR was unplanned for a related complication. If a separate, unrelated hand procedure is performed during the global window, use modifier 79. Bilateral involvement coded on the same date requires modifier 50.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 18.2 |
| Practice expense RVU | 18.03 |
| Malpractice RVU | 3.88 |
| Total RVU | 40.11 |
| Medicare national rate | $1,339.71 |
| 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 | $1,339.71 |
HOPD (APC 5112) Hospital outpatient department | $1,642.82 |
ASC (PI A2) Ambulatory surgical center (freestanding) | $872.87 |
Common denial reasons
The recurring reasons claims for CPT 26590 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Missing or vague operative note that does not describe the specific tissues reduced or techniques used.
- Staged repeat procedure billed without modifier 58, triggering global period bundling denial.
- ICD-10 diagnosis does not support medical necessity — generic 'finger deformity' codes without specificity.
- Bilateral macrodactyly repair billed without modifier 50, or billed as two units without payer-specific guidance.
- Procedure billed in a facility setting where supporting documentation (e.g., anesthesia record, pathology if tissue sent) is incomplete.
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 4 cited references ↓
01Can 26590 be billed for both hands on the same date?
02Macrodactyly often requires multiple surgeries. How do you handle the global period for staged procedures?
03Is modifier 22 ever appropriate for 26590?
04What ICD-10 codes pair with 26590?
05Does the 90-day global period affect billing for hand therapy referrals after macrodactyly repair?
06Can 26590 be performed in an ASC, and does site of service affect payment?
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 digit(s) involved, tissue components addressed (osseous, lipomatous, neurovascular), surgical technique for each component, and whether the procedure is part of a planned staged series. This directly prevents the most common denial for 26590: an operative note that says 'finger deformity repaired' without the specificity auditors need to confirm the procedure matches the code and support medical necessity.
See how Mira captures CPT 26590 documentation