Closed reduction with manipulation of a carpometacarpal fracture-dislocation at the base of the thumb (Bennett fracture) — no incision made.

Verified May 8, 2026 · 5 sources ↓

Medicare: $483.65
Total RVUs: 14.48
Global, days: 90
Region: Hand

Drawn from CMSAAPCEmednyFastrvu

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Confirm no skin incision was made — distinguish clearly from percutaneous (26650) or open (26665) treatment
Document that manipulation was performed; without-manipulation Bennett fracture treatment uses a different code family
Specify laterality (right or left thumb) to support LT/RT modifier and match ICD-10 seventh character
Record imaging findings (pre- and post-reduction X-rays) confirming the fracture-dislocation pattern at the first CMC joint
Note the type of immobilization applied (thumb spica cast, splint) — this is bundled and confirms the encounter was definitive treatment
Record anesthesia type if used; general or regional anesthesia may support modifier 22 if significantly increased complexity is documented

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 5 cited references ↓

CPT 26645 covers closed treatment of a Bennett fracture: an intra-articular fracture-dislocation at the carpometacarpal joint of the thumb. The surgeon manually manipulates the fragment back into alignment without opening the skin. No percutaneous pins, screws, or plates are placed — if fixation is added, step up to 26650 (percutaneous) or 26665 (open). Cast or splint application is bundled; don't bill separately for immobilization placed at the same encounter.

The 90-day global period covers the day-before visit, the procedure, and all routine post-op management through day 90. Separate E&M during the global requires modifier 24 (unrelated) or 25 (same-day, separately identifiable decision). Manipulation that fails and converts to open treatment at the same encounter is reportable only as 26665 — not both codes.

ICD-10 coding requires specificity: S62.211A (right, initial closed), S62.212A (left, initial closed), or S62.213A (unspecified). Seventh-character A is for the initial encounter; D for subsequent; S for sequela. Mismatched laterality between the ICD-10 and any LT/RT modifier is a fast path to denial.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	4.47
Practice expense RVU	9.05
Malpractice RVU	0.96
Total RVU	14.48
Medicare national rate	$483.65
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	$483.65
HOPD (APC 5112) Hospital outpatient department	$1,642.82
ASC (PI A2) Ambulatory surgical center (freestanding)	$872.87

Common denial reasons

The recurring reasons claims for CPT 26645 get rejected.

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

Laterality mismatch — LT/RT modifier conflicts with ICD-10 S62.211/212 side designation
Billing 26645 alongside 26650 or 26665 for the same thumb at the same encounter — only the most extensive procedure is reportable if escalation occurred
Separate cast or splint code (e.g., 29085) billed with 26645 — immobilization is bundled per NCCI fracture/dislocation rules
Missing seventh character on ICD-10 code — payers reject S62.21x without the required seventh character (A, D, or S)
E&M billed same-day without modifier 25, or post-op E&M billed within the 90-day global without modifier 24

Frequently asked questions

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

01What is the difference between 26645, 26650, and 26665 for a Bennett fracture?

26645 is closed manipulation only — no fixation hardware, no skin entry. 26650 adds percutaneous pin fixation under fluoroscopy. 26665 is open reduction with or without internal fixation. Use the most extensive procedure actually performed; if closed reduction fails and you convert to open at the same encounter, bill only 26665.

02Can I bill a cast application separately with 26645?

No. Per NCCI fracture/dislocation rules, the application of a cast, splint, or strap at the time of fracture treatment is bundled into the fracture code. Don't bill 29085 or any splint code alongside 26645 for the same encounter.

03Which ICD-10 codes pair with 26645?

S62.211A (Bennett's fracture, right hand, initial encounter for closed fracture), S62.212A (left hand), or S62.213A (unspecified hand). The seventh character must match the encounter type — A for initial, D for subsequent, S for sequela. Submitting only six characters will reject.

04Does 26645 carry a global period, and what does that mean for post-op visits?

Yes — 90-day global. All routine follow-up through day 90 is bundled. Bill a separate E&M within the global only with modifier 24 for unrelated problems or modifier 25 for a same-day significantly identifiable visit. Billing post-op visits without those modifiers triggers automatic bundling edits.

05When is modifier 22 appropriate for 26645?

When documented circumstances significantly increase intraservice work — for example, an unusually comminuted fragment pattern requiring extended manipulation time, or a patient whose anatomy (prior surgery, severe edema) substantially complicates reduction. The operative note must quantify the added complexity; a generic 'difficult case' statement will not survive audit.

06Is modifier 50 ever valid for 26645?

Bilateral Bennett fractures are rare but not impossible. If both thumbs are treated at the same encounter, modifier 50 is appropriate. Document both thumbs in the operative note and confirm the payer accepts modifier 50 vs. requiring separate line items with LT and RT.

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 procedure name (closed treatment, Bennett fracture), confirms no incision was made, records the manipulation technique, laterality, imaging correlation, and immobilization type from dictation. That detail prevents the two most common denials for 26645: missing laterality and ambiguous procedure type that auditors use to question whether 26645 vs. 26650 was the correct code.

See how Mira captures CPT 26645 documentation