Closed treatment of a metacarpal fracture with manipulation, involving manual reduction and immobilization without surgical opening of the fracture site.

Verified May 8, 2026 · 5 sources ↓

Medicare: $376.43
Work RVU: 2.95
Global, days: 90
Region: Hand

Drawn from CMSAAPCAoassnAAOS

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Explicit documentation that manual manipulation/reduction was performed — absence of this distinction triggers downcoding to 26600
Pre-reduction and post-reduction alignment, ideally supported by imaging comparison notes
Type and location of metacarpal fracture (which metacarpal, shaft vs. neck vs. base, angulation degree)
Immobilization method applied (cast vs. splint, material, position of immobilization)
Neurovascular status of the digit before and after reduction
Laterality clearly stated (left vs. right hand) to support LT/RT modifier use

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

25 Significant separate E/M 24 Unrelated E/M during global 52 Reduced services 58 Staged or related 79 Unrelated during global 78 Unplanned return — related LT Left side RT Right side 50 Bilateral procedure 22 Increased complexity

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

26605 covers closed reduction of a displaced metacarpal fracture — the physician manually manipulates the fracture fragments back into alignment and applies external immobilization (cast or splint). No incision is made. This is the go-to code when the fracture requires active reduction, distinguishing it from 26600, which is used when no manipulation is needed. The 90-day global period includes the reduction, all follow-up visits, and routine casting changes through day 90. Anything outside routine fracture management — a new injury, an unrelated condition, or a complication requiring a return procedure — requires the appropriate modifier to bill separately.

The distinction between 26600 and 26605 hinges entirely on whether manipulation occurred. If the operative note or encounter note documents only splint application without reduction, 26600 applies. Document the fracture's pre- and post-reduction alignment, the reduction technique, and the immobilization method applied. When fractures occur on both hands, report with LT and RT modifiers; bilateral same-hand scenarios require attention to NCCI edits and correct modifier application. If the same-day cast application is performed, splint/cast codes (e.g., 29075) are typically bundled into the global and not separately billable.

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 (2.95) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (11.27) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	2.95
Practice expense RVU	7.71
Malpractice RVU	0.61
Total RVU	11.27
Medicare national rate	$376.43
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	$376.43
HOPD (APC 5111) Hospital outpatient department	$252.01
ASC (PI A2) Ambulatory surgical center (freestanding)	$135.54

Common denial reasons

The recurring reasons claims for CPT 26605 get rejected.

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

Downcoded to 26600 when documentation does not explicitly describe manipulation or reduction maneuver
Cast or splint application code billed separately on the same date — bundled into the 90-day global
Missing laterality modifier when bilateral metacarpal fractures are treated on the same date
E/M visit billed same-day without modifier 25, resulting in denial of the E/M as bundled into fracture care
Fracture care submitted without radiographic evidence or imaging reference supporting the diagnosis and reduction

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01What is the difference between 26600 and 26605?

26600 is for metacarpal fractures treated without manipulation — splint or cast applied to a fracture already in acceptable alignment. 26605 requires documented manual reduction. If you touched the fracture to move it, use 26605. If you just immobilized it, use 26600.

02Can I bill a cast application code (e.g., 29075) separately on the same day as 26605?

No. The initial cast or splint applied as part of fracture care is bundled into 26605. Separate billing of 29075 on the same date will be denied. Subsequent cast changes after the initial encounter may be billable within the global period rules.

03How do I bill bilateral metacarpal fractures treated on the same date?

Report 26605 on two separate claim lines with LT and RT modifiers. For Medicare ASC billing, this is the required approach. For facility-based bilateral reporting, follow your MAC's guidance on modifier 50 vs. LT/RT line-item billing.

04Can I bill an E/M visit on the same day as 26605?

Yes, but modifier 25 is required on the E/M to show it was a significant, separately identifiable service beyond the decision to treat the fracture. Without modifier 25, the E/M will be denied as bundled into the procedure.

05What global period applies to 26605 and what does it include?

26605 carries a 90-day global. That covers the reduction, the day-before visit if applicable, and all routine post-op visits through day 90. Unrelated procedures in that window need modifier 79; complications requiring a return to the OR for a related procedure need modifier 78.

06When is modifier 22 appropriate with 26605?

Modifier 22 applies when the reduction required substantially greater effort than typical — for example, a severely comminuted fracture, significant swelling requiring prolonged manipulation, or obesity complicating the procedure. The operative note must document why the work exceeded the norm. Expect a payer cover letter request.

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 reduction technique, pre- and post-manipulation alignment, immobilization type and position, and laterality directly from dictation — the four elements auditors most frequently find missing when 26605 is downcoded to 26600. Explicit reduction language in the note removes the ambiguity that drives those denials.

See how Mira captures CPT 26605 documentation