Closed reduction of a metacarpal fracture with manual manipulation and application of external fixation hardware, billed per bone treated.

Verified May 8, 2026 · 6 sources ↓

Medicare: $497.34
Work RVU: 5.34
Global, days: 90
Region: Hand

Drawn from CMSAAPCNIHBedrockbillingEmedny

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Identify the specific metacarpal bone(s) treated by number (1st through 5th) and laterality (left or right hand)
Describe the manipulation technique used to achieve fracture reduction, including any fluoroscopic confirmation of alignment
Document the type of external fixation applied (e.g., uniplanar frame, K-wire external construct, pins and connecting rod) and placement details
State that treatment was closed — no surgical incision — to distinguish from 26615 (open treatment)
Record pre- and post-reduction imaging findings confirming alignment
Note anesthesia type used (local, regional block, sedation, general) to support facility setting claims

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 58 Staged or related 76 Repeat, same 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 ↓

26607 covers closed (no incision) reduction of a metacarpal fracture where the surgeon manually realigns the bone and then applies external fixation — pins, wires, or a frame anchored outside the skin — to maintain that alignment through healing. The descriptor specifies 'each bone,' so if two metacarpals are treated in the same session, 26607 is reported twice with modifier 51 on the second unit.

This code sits in a tightly bundled neighborhood. 26607 and 26608 (percutaneous skeletal fixation) cannot both be reported for the same bone in the same session — NCCI bundles them. If the operative note documents both K-wire pinning and a uniplanar external fixator on the same metacarpal, the correct approach is 26608 as the primary code, with a separate line for the fixator device, not a dual-code 26607/26608 stack. Using modifier 59 to unbundle them on the same bone will not survive an audit.

The global period is 90 days. All routine follow-up, hardware monitoring visits, and dressing changes through day 90 are included. A second surgery to remove or adjust external fixation hardware during the global period requires modifier 78 if related and unplanned, or modifier 58 if staged and planned at the time of the original procedure. An unrelated procedure in that window needs modifier 79.

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 (5.34) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (14.89) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	5.34
Practice expense RVU	8.41
Malpractice RVU	1.14
Total RVU	14.89
Medicare national rate	$497.34
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	$497.34
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 26607 get rejected.

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

Billing 26607 and 26608 together for the same metacarpal — NCCI bundles these and the pair will deny without a valid modifier rationale
Missing laterality modifier (LT or RT) when treating a single hand, flagged by many commercial payers and Medicare
Diagnosis code mismatch — fracture ICD-10 must specify the same metacarpal number and laterality documented in the operative note
Global period conflict — E&M or procedure billed within the 90-day global without modifier 24, 25, 78, or 79 as appropriate
Incorrect unit count — billing a single unit of 26607 when operative note clearly documents two separate metacarpal bones treated

Frequently asked questions

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

01Can I bill 26607 and 26608 together when the surgeon placed both K-wires and an external fixator on the same metacarpal?

No. NCCI bundles 26607 and 26608 for the same bone in the same session. When both K-wire pinning and an external fixator are used on one metacarpal, report 26608 as the primary code and bill the fixator device separately. A modifier 59 on 26607 will not override the edit when the same bone is involved.

02How do I bill when two separate metacarpals are treated with closed reduction and external fixation in the same operative session?

Report 26607 once for the first bone at full value, then a second line for 26607 with modifier 51 for the additional bone. Each unit requires its own bone-specific documentation in the operative note.

03What modifier applies if the external fixation hardware needs adjustment or removal under anesthesia within the 90-day global period?

Use modifier 78 if the return to the OR was unplanned and the hardware complication is related to the original fracture treatment. Use modifier 58 if the staged removal was anticipated and documented at the time of the initial procedure.

04Is laterality required on the claim for 26607?

Yes. Append LT or RT to identify which hand was treated. Many Medicare Administrative Contractors and commercial payers will deny or return the claim without it, particularly when billing bilateral procedures.

05What is the global period for 26607 and what does it include?

26607 carries a 90-day global period. That covers the day-before visit, the procedure itself, and all routine post-op care through day 90 — including fracture checks, dressing changes, and hardware monitoring visits. Bill unrelated E&M services in that window with modifier 24.

06How does 26607 differ from 26605 and 26615?

26605 is closed reduction with manipulation but without external fixation. 26607 adds the external fixation component. 26615 is open treatment — an incision is made — and includes internal fixation when performed. Choose the code that matches exactly what the operative note documents; upcoding to 26607 when no external fixation was applied is an audit risk.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira AI Scribe

From dictation, Mira's AI scribe captures the specific metacarpal number (1st–5th), laterality, manipulation technique, fluoroscopy confirmation, and the exact external fixation construct applied. That detail prevents the two most common denials for 26607: laterality omission and documentation that can't distinguish closed treatment from percutaneous fixation (26608). When multiple bones are treated, the scribe flags the per-bone billing requirement so the coder can report the correct unit count with modifier 51.

See how Mira captures CPT 26607 documentation