Closed treatment of a single metacarpal fracture without manipulation — splinting, casting, or buddy taping with no reduction attempt.

Verified May 8, 2026 · 7 sources ↓

Medicare: $341.69
Total RVUs: 10.23
Global, days: 90
Region: Hand

Drawn from CMSKzanowAAPCCgsmedicare

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 metacarpal(s) are fractured by number (1st through 5th) and laterality (left vs. right hand)
Document that no manipulation or reduction was performed — state the fracture was non-displaced or acceptably aligned
Record the type of immobilization applied (short arm cast, ulnar gutter splint, buddy strap, etc.) and who applied it
Confirm the fracture was treated closed — no percutaneous pins, no open approach
Note the mechanism of injury and whether imaging confirmed fracture alignment pre- and post-treatment
If multiple metacarpals on the same hand are fractured, document all involved bones — required to justify the single unit reported under NCCI policy

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

50 Bilateral procedure 51 Multiple procedures 52 Reduced services 58 Staged or related 59 Distinct service 76 Repeat, same physician 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

26600 covers closed, non-manipulative treatment of a metacarpal fracture. The bone is stabilized — typically with a short arm cast, ulnar gutter splint, or buddy strap — but no reduction is performed. The 90-day global period bundles the initial treatment visit, casting materials application, and all routine follow-up through day 90.

The NCCI policy creates a hard billing limit that trips up many practices: regardless of how many metacarpals are fractured on the same hand, only one unit of 26600 is billable per hand per encounter — even if the code descriptor says 'each bone.' This applies whether two bones are immobilized together in one cast or separately. Fractures on opposite hands are a different matter: bill LT and RT modifiers on separate lines (or modifier 50 for bilateral).

If any of the metacarpal fractures required manipulation, those bones should be reported with 26605 (with manipulation, without fixation) instead of 26600. Mixing displaced and non-displaced fractures managed under a single cast still limits you to one unit of 26600 for the non-manipulated bones.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	2.54
Practice expense RVU	7.2
Malpractice RVU	0.49
Total RVU	10.23
Medicare national rate	$341.69
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	$341.69
HOPD (APC 5111) Hospital outpatient department	$252.01
ASC (PI P2) Ambulatory surgical center (freestanding)	$135.54

Common denial reasons

The recurring reasons claims for CPT 26600 get rejected.

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

Billing multiple units of 26600 for multiple metacarpal fractures on the same hand — NCCI caps this at one unit per hand regardless of bone count
Using 26600 when manipulation or reduction was performed — that maps to 26605 or 26607 depending on fixation
Missing laterality when both hands are involved — claims without LT/RT or modifier 50 route to edit
Unbundling casting or strapping supply codes from the fracture care code during the global period without documentation of a separately distinct service
Incorrect ICD-10 specificity — fracture codes require laterality, displacement status, and encounter type (initial = A, subsequent = D, sequela = S)

Frequently asked questions

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

01Can I bill 26600 twice for a 4th and 5th metacarpal fracture on the same hand?

No. NCCI policy is explicit: no more than one unit of 26600 per hand per encounter, regardless of how many metacarpal bones are fractured. Bill one unit with the appropriate laterality modifier (LT or RT).

02What is the global period for 26600?

90 days. The initial treatment visit, casting, and all routine follow-up through day 90 are bundled. Use modifier 24 for unrelated E/M visits and modifier 79 for unrelated procedures performed during that window.

03How do I bill if the patient has metacarpal fractures on both hands treated the same day?

Bill 26600 with modifier 50 on a single line, or on separate lines with LT and RT. Each hand is a distinct anatomic site, so bilateral billing is appropriate here.

04Should I use finger modifiers (F1–F9) with 26600?

No. Finger modifiers (F1–F9) apply to finger procedures, not metacarpal fracture care. Use LT and RT for laterality on 26600.

05When does 26600 cross over to 26605?

26605 is the correct code when closed reduction — any attempt to restore alignment — is performed. If the fracture is non-displaced and you immobilize without touching the fracture position, that's 26600.

06Can I separately bill for the cast or splint applied during fracture care?

Casting and strapping applied as part of the initial fracture treatment are bundled into the 26600 global. Separate casting codes are only billable when applied at a subsequent visit by a different provider or when the supply is not already included in the procedure's work.

07What if a displaced and a non-displaced metacarpal are both managed under the same cast?

The non-displaced bone is limited to one unit of 26600. The displaced bone reduced and immobilized should be reported with 26605. The single-cast scenario does not override the need to report the manipulated fracture correctly — document each bone's treatment distinctly.

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 fracture location (metacarpal number, left vs. right), displacement status, the exact immobilization method applied, and explicit confirmation that no reduction was attempted. That documentation directly prevents the two most common audit flags: upcoding to 26605 when no manipulation occurred, and NCCI denials when multiple metacarpals are involved but only one unit is billable.

See how Mira captures CPT 26600 documentation