Open surgical repair of a Bennett fracture — a fracture-dislocation at the base of the thumb metacarpal where it meets the trapezium — with or without internal or external fixation.

Verified May 8, 2026 · 7 sources ↓

Medicare: $577.84
Work RVU: 7.74
Global, days: 90
Region: Hand

Drawn from CMSAAPCEatonhandMdclarityAaoms

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Operative note must state the fracture pattern by name (Bennett, Rolando, or describe intra-articular CMC fracture-dislocation) — vague terms like 'thumb fracture' do not support 26665 over lower-valued codes.
Document whether internal fixation (K-wires, screws) or external fixation was used, or explicitly state fixation was not applied.
Describe the surgical approach and joint exposure — confirm the CMC joint was directly visualized and reduced.
Pre-op imaging (X-ray or CT) confirming displacement and intra-articular involvement must be in the record.
Indicate laterality (left vs. right thumb) to support LT or RT modifier and match ICD-10 diagnosis code.
For modifier 22 claims, provide a separate narrative quantifying the additional work — comminution, soft tissue injury, prolonged operative time.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 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 LT Left side RT Right side 80 Assistant surgeon AS PA/NP/CNS assistant

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 26665 covers open treatment of a carpometacarpal fracture-dislocation of the thumb, the injury pattern classically known as a Bennett fracture. The procedure requires an incision to directly visualize the fracture site, reduce the displaced metacarpal base, and restore the carpometacarpal joint. Fixation — K-wires, screws, or external fixation — may or may not be used; the code is the same regardless. This is a 90-day global code, so all routine post-op management through day 90 is bundled.

Don't confuse 26665 with 26645 (closed treatment of the same fracture pattern, with manipulation) or 26615 (open treatment of a non-articular metacarpal fracture). The defining feature of 26665 is the intra-articular, fracture-dislocation character at the CMC joint of the thumb. A Rolando fracture — a comminuted variant of the same injury — is also commonly reported under 26665, though documentation should clearly describe the fracture pattern to support that selection.

The 90-day global period means the day-before visit, the operative day, and all routine post-op encounters are bundled into the surgical fee. Unrelated E/M visits in that window require modifier 24. A return to the OR for a related complication (e.g., loss of reduction, hardware failure) requires modifier 78. A staged or planned secondary procedure uses modifier 58.

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 (7.74) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (17.3) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	7.74
Practice expense RVU	8.24
Malpractice RVU	1.32
Total RVU	17.3
Medicare national rate	$577.84
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	$577.84
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 26665 get rejected.

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

Upcoding flag when operative note describes a closed or percutaneous reduction but 26665 (open treatment) is billed — the note must confirm open incision and direct visualization.
Laterality mismatch between the CPT modifier (LT/RT), the ICD-10 code, and the operative note.
Bundling denials when 26665 is billed same-day with other hand fracture codes without modifier 59 or an X-modifier and documentation of anatomically distinct fracture sites.
Global period denials for post-op E/M visits billed without modifier 24 when the visit is unrelated, or without modifier 79 for unrelated OR procedures during the 90-day window.
Missing or insufficient pre-op imaging documentation to justify surgical necessity for open treatment.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01Does 26665 cover both Bennett and Rolando fractures?

Yes. Both are intra-articular CMC fracture-dislocations of the thumb metacarpal base. 26665 is the correct code for open treatment of either pattern. Document the fracture type by name in the operative note — auditors will scrutinize Rolando claims more closely given the comminution, which may also support modifier 22 if the added complexity is well documented.

02What's the difference between 26665 and 26645?

26645 is closed treatment of the same fracture-dislocation pattern (with manipulation). 26665 requires an open incision with direct visualization of the joint. If you attempted closed reduction and then converted to open, bill 26665 — the open approach drives code selection.

03Can I bill 26665 and 26615 together if the patient has a concurrent metacarpal shaft fracture?

Potentially yes, with modifier 59 (or XS) on 26615 to indicate a distinct anatomical site. The fractures must be at separate locations and both clearly documented. Check NCCI edits before billing — payers may still bundle without sufficient documentation of distinct procedures.

04How do I handle a same-day E/M when the decision for surgery is made at that visit?

Use modifier 57 on the E/M if the decision for major surgery (90-day global) is made at that encounter. Modifier 25 applies to same-day E/M with minor procedures (0- or 10-day global), not 90-day global codes like 26665.

05If the patient loses reduction and needs a return to the OR, what modifier applies?

Modifier 78 — unplanned return to the OR for a related procedure during the global period. Loss of reduction on a Bennett fracture repair is related to the original surgery. If you're performing a new, unrelated procedure on the same patient during the 90-day global, that's modifier 79.

06Is 26665 billable bilaterally?

Bilateral Bennett fractures are rare, but if it occurs, append modifier 50. Verify with the payer — some commercial payers and Medicare contractors have bilateral billing rules specific to hand fracture codes. Always confirm the Medicare Physician Fee Schedule bilateral indicator for 26665 before submitting.

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 (Bennett vs. Rolando vs. comminuted intra-articular), confirmation of open incision and direct CMC joint visualization, fixation method (K-wire, screw, external frame, or none), and thumb laterality from the surgeon's dictation. That prevents the most common 26665 denial: an operative note that reads like a closed or percutaneous reduction, which downcodes the claim to 26641 or 26645 on audit.

See how Mira captures CPT 26665 documentation