Closed reduction of a carpometacarpal (CMC) dislocation other than the thumb, at a single joint, performed under anesthesia

Verified May 8, 2026 · 6 sources ↓

Medicare: $515.38
Work RVU: 4.71
Global, days: 90
Region: Hand

Drawn from CMSAAPCEatonhandGenhealthAAOS

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) treated and confirm it is not the thumb CMC (Bennett fracture territory)
Document the type and administration of anesthesia used (e.g., regional wrist block, IV sedation, general) — critical for defending the 'requiring anesthesia' descriptor
Record pre- and post-reduction neurovascular status of the affected digit(s)
Describe the mechanism of injury and radiographic confirmation of dislocation prior to manipulation
Post-reduction imaging report confirming restoration of alignment
Immobilization method applied after reduction (splint, cast type, duration)

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 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

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 26675 covers closed (non-incisional) manipulation of a dislocated carpometacarpal joint — specifically the CMC joints of digits 2 through 5, excluding the thumb's CMC (Bennett fracture territory). The procedure requires anesthesia, which distinguishes it from the without-anesthesia counterpart. The surgeon manually restores anatomic alignment of the displaced joint without opening the skin.

The 90-day global period means all routine follow-up, casting checks, and dressing changes through day 90 are bundled. If the reduction fails and open treatment becomes necessary during that window, bill the open procedure with modifier 58 (staged/related) to reset the global clock. An unrelated procedure in the same period takes modifier 79.

The 'requiring anesthesia' language in the descriptor is a common point of confusion: it does not mandate general anesthesia specifically. Regional block (e.g., wrist block) satisfies the requirement. However, if only a digital block or local infiltration at the joint is used, some payers argue the lower-complexity without-anesthesia code applies — document the anesthetic technique explicitly to defend code selection.

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 (4.71) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (15.43) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	4.71
Practice expense RVU	9.7
Malpractice RVU	1.02
Total RVU	15.43
Medicare national rate	$515.38
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	$515.38
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 26675 get rejected.

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

Anesthesia type not documented — payer downcodes to the without-anesthesia CMC dislocation code when the operative note lacks explicit anesthetic details
Thumb CMC dislocation coded as 26675 — Bennett fracture-dislocation has its own code family; using 26675 for the thumb triggers denial or audit
Routine follow-up billed separately within the 90-day global period without a supporting modifier
Missing pre- or post-reduction imaging documentation, leaving medical necessity unsupported
Bilateral CMC dislocations billed without modifier 50 or LT/RT designation

Frequently asked questions

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

01Does 26675 require general anesthesia specifically?

No. 'Requiring anesthesia' in the descriptor means anesthesia beyond simple local infiltration at the joint. A regional wrist block or IV sedation satisfies the requirement. Document the technique explicitly — if the note just says 'local,' expect a downcode challenge.

02Can 26675 be billed for a thumb CMC dislocation?

No. The descriptor explicitly excludes the thumb CMC (Bennett fracture-dislocation territory). Billing 26675 for the thumb is a miscoding error. Use the appropriate thumb CMC dislocation or Bennett fracture code family instead.

03What if multiple CMC joints are dislocated and reduced at the same session?

The code descriptor specifies 'single' joint. If you reduce more than one non-thumb CMC joint, bill 26675 for the primary joint and append modifier 59 (or consider modifier 22 if the complexity was substantially greater). Document each joint treated.

04If the closed reduction fails and open treatment is performed later, how do you bill?

Use modifier 58 on the open treatment code. This signals a staged/related procedure within the global period and resets the 90-day global clock from the date of the open procedure.

05Is a same-day E/M separately billable with 26675?

Only if a significant, separately identifiable service beyond the pre-procedure evaluation was performed. Append modifier 25 to the E/M. The decision-for-surgery visit (day of or day before, for a 90-day global) uses modifier 57 on the E/M instead.

06How does the 90-day global affect follow-up casting or splint changes?

Routine cast checks, splint adjustments, and dressing changes are bundled through day 90. Bill separately only for services unrelated to the CMC dislocation (modifier 24 on the E/M) or for complications requiring a return to the OR (modifier 78).

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 treated (identifying it as a non-thumb joint), the anesthetic technique used (regional block, sedation, or general), the manipulation maneuver performed, and the post-reduction immobilization applied — directly from dictation. That prevents the two most common downcodes: missing anesthesia documentation and ambiguous joint identification that triggers thumb-CMC (Bennett) miscoding.

See how Mira captures CPT 26675 documentation