Closed reduction of a thumb carpometacarpal (CMC) joint dislocation using manual manipulation, without surgical incision.

Verified May 8, 2026 · 6 sources ↓

Medicare: $469.28
Total RVUs: 14.05
Global, days: 90
Region: Hand

Drawn from CMSAAPCEatonhandEmednyBedrockbilling

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Imaging (X-ray) confirming CMC dislocation at the thumb base, with no fracture fragment to distinguish from Bennett fracture-dislocation (26645)
Description of reduction technique, including direction of force applied and confirmation of successful reduction
Post-reduction imaging documenting restored joint alignment
Type of immobilization applied after reduction (thumb spica cast, splint, or strapping) and duration prescribed
Laterality documented explicitly (right vs. left thumb) to support LT/RT modifier assignment
Anesthesia type used, if any, to support appropriate code selection and facility billing

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 25 Significant separate E/M 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 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 ↓

CPT 26641 covers closed manipulation of a dislocated thumb carpometacarpal joint — the articulation between the first metacarpal and the trapezium, near the base of the thumb and wrist. The treating physician manually reduces the dislocated joint to anatomic position without open surgery. A cast, splint, or strapping is typically applied after reduction to maintain alignment through the 90-day global period.

This code is distinct from 26645 (Bennett fracture-dislocation with manipulation), which requires a fracture component at the same joint. If imaging confirms a pure dislocation with no fracture, 26641 is correct. If there is an associated intra-articular fracture fragment, 26645 applies instead. Do not bill both codes for the same thumb joint on the same date — NCCI bundling principles treat a single cast or stabilization as covering one anatomic area, one code.

The 90-day global period includes the day before surgery, the procedure day, and all routine follow-up through day 90. Billed E/M or other services within that window for the same condition require modifier 24 (unrelated E/M) or 25 (separate, significant E/M on the day of the procedure). An unplanned return to address a related complication within the global uses modifier 78; an unrelated procedure in the same period uses 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	4.03
Practice expense RVU	9.16
Malpractice RVU	0.86
Total RVU	14.05
Medicare national rate	$469.28
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	$469.28
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 26641 get rejected.

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

Miscoding as 26645 (Bennett fracture-dislocation) when imaging shows pure dislocation without fracture, or vice versa
Missing post-reduction imaging in the operative or procedural note, leaving reduction success unconfirmed
E/M billed same-day during the global period without modifier 25, triggering automatic bundling denial
Laterality not specified, causing claim rejection at payers requiring LT or RT modifier on unilateral procedures
Casting or splint billed separately when applied immediately after the reduction — included in 26641

Frequently asked questions

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

01How does 26641 differ from 26645?

26641 is for a pure CMC dislocation of the thumb with no fracture. 26645 is for a Bennett fracture-dislocation, which involves an intra-articular fracture fragment at the same joint. The distinction hinges on imaging findings — bill based on what the X-ray shows, not just the clinical presentation.

02Can you bill a splint or cast separately after performing 26641?

No. Application of a cast, splint, or strapping immediately following closed reduction of a dislocation is bundled into 26641 under NCCI policy. Separate billing for the immobilization will be denied.

03Is modifier 50 appropriate if both thumbs are dislocated and reduced in the same session?

Yes. If both CMC joints are reduced at the same encounter, append modifier 50 and bill a single line. Medicare reimburses bilateral procedures at 150% of the single-procedure rate.

04What modifier applies if the patient returns during the 90-day global for a follow-up procedure on the same thumb?

Use modifier 78 for an unplanned return to the procedure room for a complication related to the original reduction. Use modifier 79 for a procedure unrelated to the thumb dislocation performed during the same global period.

05Can 26641 be billed with an E/M on the same date as the reduction?

Only if the E/M was a separately identifiable, significant service beyond the decision to perform the reduction. Append modifier 25 to the E/M. A brief pre-procedure assessment that's entirely folded into the decision to reduce does not qualify.

06Does 26641 require an operating room, or can it be billed in an office or ED setting?

26641 can be performed in any setting where the reduction is clinically appropriate — office, ED, ASC, or hospital. Site of service affects the facility payment rate; see the site of service comparison table for HOPD vs. ASC payment differences.

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 joint name (carpometacarpal, first CMC), direction of dislocation, reduction maneuver used, anesthesia type, post-reduction alignment confirmed on X-ray, immobilization type applied, and explicit laterality from dictation. That prevents the two most common audit flags for 26641: missing post-reduction imaging documentation and failure to distinguish the injury from a Bennett fracture, which would require 26645 instead.

See how Mira captures CPT 26641 documentation