Open surgical treatment of a single metacarpal fracture, with or without internal or external fixation, billed per bone.

Verified May 8, 2026 · 6 sources ↓

Medicare: $547.77
Total RVUs: 16.4
Global, days: 90
Region: Hand

Drawn from CMSAAPCEatonhandAbos

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(s) treated by number and laterality (e.g., right 3rd metacarpal)
State fixation method explicitly: plate and screws, K-wires, external fixator, or no fixation
Document the surgical approach and wound extent — 'standard approach' language flags audits
For multi-bone cases, document each bone as a discrete operative step with findings and fixation
Record pre-op imaging confirming fracture pattern and displacement necessitating open treatment
If bone graft was used, document graft type (autograft, allograft), source, and volume

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 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

26615 covers open operative treatment of a metacarpal fracture — one of the five long bones connecting the wrist to the fingers. The code applies whether or not hardware (plates, screws, K-wires, or external fixation) is placed; fixation method doesn't change the code. It carries a 90-day global period, meaning routine follow-up, dressing changes, and hardware checks through day 90 are bundled. Use modifier 24 for unrelated E/M visits and modifier 79 for unrelated procedures performed during that window.

When multiple metacarpals are fractured and opened in the same session, bill 26615 for each bone separately. Payer preference on how to distinguish the additional units varies: modifier 51 on subsequent codes, units on the claim line, or HCPCS digit modifiers (F1–F9) for different fingers are all used in practice. Confirm carrier preference before submitting — most payers reduce subsequent procedure fees approximately 50% regardless of approach. If you're billing a closed reduction (26605) on one metacarpal and an open repair (26615) on another in the same session, 26605 is a column-2 code to 26615; append modifier 59 or XS to 26605 to support separate reimbursement.

Simple wound closure (e.g., 12005) is bundled into 26615 under NCCI and is not separately billable. Bone allograft, when used, may be separately reported with appropriate grafting codes. Document the specific bone(s) treated, fixation method used, and approach in the operative note — vague language like 'metacarpal ORIF' without specifying which bone triggers audits and denials.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	6.89
Practice expense RVU	8.18
Malpractice RVU	1.33
Total RVU	16.4
Medicare national rate	$547.77
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	$547.77
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 26615 get rejected.

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

Bundling denial when 26605 is billed same-day without modifier 59 or XS
Multiple units of 26615 denied for lack of distinct per-bone documentation in the operative note
Simple wound closure billed separately — NCCI bundles repair codes like 12005 into 26615
Missing laterality modifier (LT/RT) required by many payers for hand procedures
Post-op E/M or follow-up visit denied during 90-day global without modifier 24

Frequently asked questions

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

01Can I bill 26615 twice when I open two metacarpals in the same session?

Yes — 26615 is billed per bone. Bill it for each metacarpal treated open. Append modifier 51 to the second code, or use units on the claim line, or use HCPCS digit modifiers F1–F9 if different fingers are involved. Confirm carrier preference first; most payers reduce subsequent procedure fees regardless of approach.

02Do I need a modifier when billing 26615 with 26605 on the same day?

Yes. 26605 (closed treatment of metacarpal fracture) is a column-2 code to 26615 under NCCI. If you performed a closed reduction on one metacarpal and an open repair on another, append modifier 59 or XS to 26605 to establish it as a distinct procedural service on a different bone.

03Is wound closure separately billable with 26615?

No. NCCI bundles simple wound closure codes (e.g., 12005) into 26615. Do not bill them separately — payers will deny and the denial is not appealable on a modifier-59 argument for closure of the same surgical wound.

04What is the global period for 26615 and what does it cover?

26615 carries a 90-day global period. That covers the surgery itself, the day-before preoperative visit, and all routine post-op care through day 90 — including dressing changes, suture removal, and hardware checks. Unrelated E/M visits need modifier 24; a related staged procedure needs modifier 58; an unrelated procedure needs modifier 79.

05Can I separately bill for bone graft used during metacarpal ORIF?

Yes, bone graft is not bundled into 26615. Report the appropriate grafting code separately for autograft or allograft when used. Document graft type, source, and volume in the operative note to support the additional charge.

06Which laterality modifier should I use for hand fracture cases?

Use LT for left hand and RT for right hand. Many payers — including Medicare contractors — require laterality on hand procedure claims. Missing laterality is a common clean-claim failure that delays payment even when the clinical documentation is complete.

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 number, laterality, fixation method (plate/screws, K-wires, external fixator, or none), and each bone treated as a discrete operative step. That per-bone granularity is what prevents same-day multi-unit denials and gives you the documentation to defend modifier 59 or XS when a closed reduction on a separate metacarpal is also billed.

See how Mira captures CPT 26615 documentation