Closed reduction of a carpometacarpal (CMC) dislocation — excluding the thumb — performed with manipulation, reported per joint treated.

Verified May 8, 2026 · 6 sources ↓

Medicare: $429.87
Work RVU: 3.73
Global, days: 90
Region: Hand

Drawn from CMSFindacodeAAPCBedrockbillingEatonhand

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 CMC joint(s) dislocated and confirm thumb/Bennett fracture is excluded
Document that closed manipulation was performed without anesthesia
Record pre- and post-reduction clinical or imaging findings confirming alignment
Note whether a cast, splint, or strap was applied and who will assume follow-up care
If multiple joints treated, document each joint separately to support per-joint reporting
If modifier 22 used, include explicit narrative describing why the work exceeded typical effort

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 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 XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 26670 covers closed (non-surgical) reduction of a carpometacarpal dislocation of the hand, excluding the thumb and its associated Bennett fracture-dislocation. The physician manually manipulates the displaced CMC joint back into anatomic alignment without anesthesia. The code is reported per joint, so if two separate CMC joints are reduced in the same session, you report the code twice with modifier 59 to distinguish each discrete joint treatment.

The 90-day global period means casting, splinting, and all routine follow-up visits through day 90 are bundled — you cannot separately bill strapping or splint application codes when you've already reported 26670. Per NCCI policy, if you apply a splint as part of the initial treatment and assume ongoing care, the splint code is included. The exception: if a covering provider applies the splint without assuming follow-up, they may separately report the casting/splinting code instead.

Site of service matters here. Facility payments differ from non-facility; see the site of service comparison table for current 2026 figures. If the work required is substantially greater than typical — for example, a chronically unreduced dislocation requiring unusual effort — document that explicitly and append modifier 22 with a supporting operative note explaining the additional work.

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 (3.73) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (12.87) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	3.73
Practice expense RVU	8.28
Malpractice RVU	0.86
Total RVU	12.87
Medicare national rate	$429.87
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	$429.87
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 26670 get rejected.

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

Splint or strapping code billed separately when 26670 was also reported with follow-up care assumed
Thumb CMC dislocation or Bennett fracture billed under 26670 instead of the correct thumb-specific code
Multiple joints reduced but only one unit reported, or duplicate units reported without modifier 59 to distinguish separate joints
Missing imaging documentation to confirm dislocation and post-reduction alignment
E/M billed same-day without modifier 25 when a separately identifiable evaluation was performed

Frequently asked questions

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

01Can I bill 26670 for a thumb CMC dislocation?

No. 26670 explicitly excludes the thumb and Bennett fracture-dislocations. Thumb CMC injuries have their own dedicated codes — billing 26670 for the thumb will result in denial or audit exposure.

02If I reduce two CMC joints in the same hand during the same visit, how do I bill?

Report 26670 twice. Append modifier 59 (or XS) to the second unit to indicate a distinct joint was treated. Document each joint separately in the operative note.

03Can I separately bill for the splint I applied after reducing the dislocation?

Not if you're assuming follow-up care. NCCI bundles casting and splinting codes into the fracture/dislocation treatment code when the same provider handles ongoing management. If a separate provider applies the splint with no expectation of follow-up, they may bill the splinting code instead.

04The patient required significantly more effort than usual due to a chronically unreduced dislocation — can I use modifier 22?

Yes, but the operative note must explicitly describe why the work exceeded typical effort. Generic language won't hold up. Name the specific factors — duration of dislocation, muscle spasm, multiple reduction attempts — and include a cover letter summarizing the additional work when submitting.

05Does the 90-day global period apply here, and what can I bill separately during it?

Yes, 26670 carries a 90-day global. Routine post-op visits, dressing changes, and splint checks are all bundled. To bill an E/M during the global for an unrelated condition, append modifier 24. For a new and separate injury or problem evaluated on the same day as the procedure, append modifier 25 to the E/M.

06What's the difference in payment between facility and non-facility settings for 26670?

There is a meaningful site-of-service difference — HOPD and ASC payments are lower than non-facility RVU-based reimbursement. See the site of service comparison table on this page for current 2026 figures.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the specific CMC joint level treated, confirmation that the thumb was not involved, the manipulation technique used without anesthesia, post-reduction alignment assessment, and whether a splint was applied and by whom. This prevents the most common audit flag — operative notes that omit joint-level specificity or fail to distinguish this procedure from thumb CMC codes, which land in the wrong code family entirely.

See how Mira captures CPT 26670 documentation