Surgical release of one or more intrinsic hand muscles — thenar, hypothenar, interossei, or lumbricals — to relieve contracture or adhesions limiting hand function. Billed per muscle released.

Verified May 8, 2026 · 6 sources ↓

Medicare: $635.62
Work RVU: 5.36
Global, days: 90
Region: Hand

Drawn from CMSAAPCAbosHandsurgeryresourceGenhealth

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Identify each specific intrinsic muscle released by name (e.g., first dorsal interosseous, adductor pollicis, lumbrical)
Document the underlying pathology causing the contracture — trauma, rheumatoid disease, spasticity, or post-repair adhesions
Describe the surgical approach and technique, including whether loupes or microscopy were used
Record pre-operative and intra-operative range-of-motion findings to justify medical necessity
If multiple muscles are released, document each separately to support multiple units of 26593
Specify laterality (left vs. right hand) in both the operative note and the claim

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 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 26593 covers open surgical release of intrinsic hand muscles — the thenar group, hypothenar group, interossei, or lumbricals — when contracture, spasticity, or post-injury adhesions restrict motion and hand function. The descriptor reads 'each muscle,' so if you release two distinct intrinsic muscles during the same operative session, you report 26593 twice. Use modifier 51 on the second unit when required by payer policy.

The 90-day global period begins on the day of surgery. Routine post-op care, splint checks, and hand therapy coordination during that window are bundled. If you treat an unrelated condition at a separate encounter during the global, append modifier 24 to the E/M code. A return to the OR for a complication directly tied to the original release uses modifier 78; an unrelated procedure in the global period uses modifier 79 — not the reverse.

Common indications include intrinsic contracture from trauma, burns, rheumatoid arthritis, or spasticity. Operative documentation must specify which muscle(s) were released, the surgical approach, and the underlying pathology driving the contracture. Vague notes citing 'intrinsic release' without naming the specific muscle are a consistent audit flag and a leading cause of down-coding or denial.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU vs. total RVU

The work RVU (5.36) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (19.03) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	5.36
Practice expense RVU	12.63
Malpractice RVU	1.04
Total RVU	19.03
Medicare national rate	$635.62
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	$635.62
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 26593 get rejected.

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

Operative note names 'intrinsic release' without identifying the specific muscle — fails medical necessity review
Multiple units of 26593 billed without per-muscle documentation to support each unit
Laterality mismatch between the operative note and the claim — LT/RT modifier absent or inconsistent
Modifier 51 missing when 26593 is reported alongside other hand procedures in the same session
ICD-10 diagnosis code does not support intrinsic contracture or the specific etiology documented in the note

Frequently asked questions

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

01Can I bill 26593 more than once if I release two intrinsic muscles in the same hand during one session?

Yes. The descriptor is 'each muscle,' so you report 26593 for each distinct intrinsic muscle released. Append modifier 51 to the second and subsequent units per payer policy, and document each muscle by name in the operative note.

02What modifier do I use when both hands are released in the same operative session?

Report 26593-RT for the right hand and 26593-LT for the left. Some payers also accept modifier 50 on a single line; confirm with the specific payer before submitting to avoid a bilateral-procedure denial.

03What ICD-10 codes most commonly pair with 26593?

M24.549 (contracture, unspecified hand joint) and more specific codes tied to the etiology — such as rheumatoid arthritis codes from the M05–M06 range, post-traumatic contracture, or burn sequelae codes — are typical. Laterality-specific codes are preferred; use unspecified only when documentation genuinely does not specify.

04Is a return-to-OR for post-release stiffness billed with modifier 78 or 79?

Use modifier 78 if the return is directly related to the original intrinsic release (e.g., managing adhesion recurrence or wound complication from that procedure). Use modifier 79 only for a genuinely unrelated procedure during the 90-day global. Inverting these modifiers is a compliance risk.

05How does the 90-day global period affect billing for hand therapy referrals and splinting within that window?

Physician services for routine post-op care and splint management are bundled into the global. The global does not prevent the therapist's separate therapy codes (97000 series) from being billed independently under the therapist's NPI. If the surgeon personally provides a separate, unrelated E/M service during the global, modifier 24 is required.

06When is modifier 22 appropriate for 26593?

Append modifier 22 when the work substantially exceeded the typical procedure — for example, severe scarring from prior burn or crush injury that significantly prolonged dissection time. The operative note must quantify the added difficulty and time. Expect a payer request for records when 22 is used.

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 intrinsic muscle released by name, the laterality, the documented etiology of contracture, intra-operative range-of-motion findings, and the surgical technique from dictation. That structured output prevents the most common denial trigger — an operative note that says 'intrinsic release' without naming the muscle — and supports multiple-unit billing when more than one muscle is addressed.

See how Mira captures CPT 26593 documentation