Percutaneous skeletal fixation of a single metacarpal fracture using pins or wires inserted through the skin to stabilize bone fragments without open exposure.

Verified May 8, 2026 · 8 sources ↓

Medicare: $464.27
Work RVU: 5.41
Global, days: 90
Region: Hand

Drawn from CMSAAPCMdclarityFindacodeEatonhand

Documentation requirements

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

Source · Editorial brief grounded in 8 cited references ↓

Confirm percutaneous fixation was performed — document that pins or wires were inserted through the skin, not just manipulation
Identify the specific metacarpal bone(s) treated; the code is billed per bone, so the operative note must name each one
Document fluoroscopic or intraoperative imaging confirming pin placement and fracture reduction
Record anesthesia type (local, regional, or general) and the surgical setting (OR or ASC)
Note fracture pattern, displacement status, and clinical justification for percutaneous fixation over closed treatment
Document whether an assistant surgeon was present if billing modifier 80 or AS

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 24 Unrelated E/M during global 51 Multiple procedures 58 Staged or related 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 8 cited references ↓

CPT 26608 covers percutaneous skeletal fixation of a metacarpal fracture, billed per bone. The surgeon inserts K-wires or similar fixation pins through the skin under fluoroscopic guidance to reduce and stabilize the fractured metacarpal without making an open incision. Intraoperative imaging confirms pin placement before the hand is dressed and the wires are left in place until healing occurs.

Because the code is defined as 'each bone,' multiple fractured metacarpals treated at the same session require additional units — one line per bone, each appended with modifier 59 to establish separate and distinct sites. The 090-day global period applies, so routine follow-up visits, cast or splint changes, and pin removal within 90 days are bundled unless a separately identifiable unrelated service is documented.

This code sits above the closed-treatment codes (26600, 26605) in complexity and below open reduction/internal fixation (26615). Selecting 26608 requires explicit documentation that percutaneous fixation was performed — not just manipulation. Operative notes that describe closed reduction without confirming pin insertion support the wrong code and are a common audit trigger.

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 (5.41) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (13.9) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	5.41
Practice expense RVU	7.42
Malpractice RVU	1.07
Total RVU	13.9
Medicare national rate	$464.27
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	$464.27
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 26608 get rejected.

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

Operative note describes closed reduction only, with no documentation that percutaneous pins were placed — supports 26605, not 26608
Multiple metacarpals treated but billed as a single unit without modifier 59 to distinguish separate bones
Routine pin removal or follow-up visit billed separately during the 90-day global period without modifier 24 or 79
Missing intraoperative imaging documentation, causing payers to question whether fluoroscopic guidance was used to confirm fixation
Fracture diagnosis code (ICD-10) does not specify the metacarpal bone or laterality, creating a CPT-ICD mismatch

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 8 cited references ↓

01Can I bill 26608 twice if I fix two metacarpals in the same session?

Yes. The code is defined per bone. Bill one unit per metacarpal treated, each line appended with modifier 59 to identify separate and distinct fracture sites. Without modifier 59, payers will bundle the second unit and deny it.

02Is pin removal during the global period separately billable?

No. Pin or wire removal within the 90-day global period is bundled. If removal requires a return to the OR under anesthesia for a complication, use modifier 78. If it falls outside the global period, bill separately with modifier 79.

03What is the difference between 26608 and 26605?

CPT 26605 is closed treatment of a metacarpal fracture with manipulation — no hardware is placed. CPT 26608 requires percutaneous fixation with pins or wires inserted through the skin. The operative note must confirm hardware placement to support 26608.

04Do I use digit modifiers (F1–FA) with 26608?

Metacarpals are not technically digits, so F1–FA modifiers don't apply to 26608 the way they do to phalangeal codes. Use LT or RT to indicate laterality, and modifier 59 when billing multiple bones on the same hand. Some payers may request digit-level detail in the narrative; check individual payer policy.

05Can 26608 and an E/M code be billed on the same day?

Only if the E/M represents a separately identifiable service unrelated to the fracture decision. Append modifier 25 to the E/M. The decision to perform the procedure itself is not a separately billable E/M service.

06When does modifier 22 apply to 26608?

Use modifier 22 when the procedure required substantially more work than typical — for example, severely comminuted fractures, malunion requiring intraoperative correction, or unusually prolonged fluoroscopic repositioning. Attach a cover letter with time and complexity documentation; payers will request it.

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 metacarpal bone treated, confirmation that percutaneous pins or wires were inserted (not just manipulation), fluoroscopic guidance use, and fracture displacement status from the surgeon's dictation. That prevents the most common audit flag — an operative note that describes closed reduction without confirming fixation hardware was placed, which forces a downcode to 26605.

See how Mira captures CPT 26608 documentation