Percutaneous skeletal fixation of a carpometacarpal fracture-dislocation of the thumb (Bennett fracture), with manipulation and pin or wire placement through the skin.

Verified May 8, 2026 · 5 sources ↓

Medicare: $470.62
Work RVU: 5.22
Global, days: 90
Region: Hand

Drawn from CMSNIHEatonhandAAOSKzanow

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Confirm the fracture involves the carpometacarpal joint of the thumb (Bennett pattern) — document intra-articular extension explicitly
Specify that manipulation was performed and document pre- and post-reduction alignment findings
Record the number, size, and placement trajectory of percutaneous pins or wires inserted
Note fluoroscopic confirmation of reduction and hardware position in the operative report
Document laterality (right or left thumb) for modifier LT or RT assignment
Describe any external fixation or splint/cast applied at the conclusion of the procedure

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 51 Multiple procedures 57 Decision for surgery 58 Staged or related 76 Repeat, same physician 77 Repeat, another 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 26650 covers closed reduction with percutaneous pinning of a Bennett fracture — the intra-articular fracture-dislocation at the base of the first metacarpal where it meets the trapezium. The surgeon manipulates the displaced fragment back into alignment, then drives Kirschner wires or pins through the skin to stabilize the construct without opening the joint. The procedure includes any fluoroscopic guidance used intraoperatively to confirm reduction and pin position.

This code carries a 90-day global period. All routine post-op visits, cast checks, and pin-site management fall inside that global. If the patient presents with an unrelated problem during the 90-day window, bill the E/M with modifier 24. If you make the decision for surgery at a separate E/M the same day or the day before, append modifier 57 to that E/M.

Don't confuse 26650 with 26645 (open reduction with internal fixation of Bennett fracture) or 26600/26605 (closed treatment without percutaneous fixation). The distinguishing element of 26650 is percutaneous hardware crossing the skin — if wires are placed, 26650 is the right code. If the fracture is reduced without hardware, use 26600 or 26605 depending on whether manipulation was performed.

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 (5.22) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (14.09) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	5.22
Practice expense RVU	7.83
Malpractice RVU	1.04
Total RVU	14.09
Medicare national rate	$470.62
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	$470.62
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 26650 get rejected.

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

Laterality modifier missing — payers require LT or RT for hand procedures; omission triggers automatic denial
Upcoding flag when operative note lacks explicit documentation of percutaneous hardware placement, making 26650 unsupportable over 26605
Bundling with same-day E/M when modifier 57 is missing and the decision for surgery was made that day
ICD-10 diagnosis code mismatch — using a closed fracture code when the Bennett fracture-dislocation requires a dislocation-specific code (S62.21x series)
Global period conflict when a post-op E/M is billed without modifier 24 and payer records flag it as included in the 90-day global

Frequently asked questions

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

01What is the difference between CPT 26650 and 26605?

26605 is closed treatment of a Bennett fracture with manipulation but without percutaneous fixation. 26650 requires percutaneous pin or wire placement across the skin. If no hardware goes through the skin, 26605 is correct. If wires are placed, 26650 applies — and the operative note must document the hardware.

02Do I need a laterality modifier for 26650?

Yes. Append LT or RT to every claim. Most payers and Medicare contractors require laterality on hand and finger procedures. Missing this modifier is one of the most common mechanical denials for 26650.

03Can I bill for pin removal separately after 26650?

Routine pin removal falls inside the 90-day global period and is not separately billable. If pin removal requires a return to the operating room or general anesthesia beyond what is typical, document that circumstance and evaluate modifier 78 for an unplanned related procedure in the global period.

04What ICD-10 codes pair correctly with 26650?

Use codes from the S62.21 series (Bennett fracture) with the appropriate 7th character for initial encounter (A), subsequent encounter (D), or sequela (S). Dislocation component codes from S63.04x may also apply. Confirm the specific laterality and encounter type character — payer edits routinely flag mismatched 7th characters.

05If the surgeon decides to perform an open reduction instead, does 26650 still apply?

No. If the surgeon opens the joint to achieve reduction or internal fixation, report 26645 (open reduction, Bennett fracture, without internal fixation) or 26650 is not applicable. 26650 is strictly percutaneous — skin is not incised beyond the wire entry points.

06Can 26650 be billed with a same-day E/M?

Only with modifier 57 on the E/M if the decision for surgery was made at that visit and the E/M is separate and distinct from the pre-procedure assessment. CMS requires that the E/M represent a significant, separately identifiable service beyond the standard pre-op evaluation.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the fracture pattern (intra-articular Bennett, degree of displacement), manipulation technique, number and gauge of percutaneous wires placed, fluoroscopic confirmation of reduction, and post-procedure immobilization applied. That detail locks in 26650 over lower-value closed-treatment codes and gives auditors the hardware documentation they look for on percutaneous fixation claims.

See how Mira captures CPT 26650 documentation