Percutaneous pin fixation of a non-thumb carpometacarpal dislocation, with closed manipulation, billed per joint treated.
Verified May 8, 2026 · 7 sources ↓
- Medicare
- $488.99
- Total RVUs
- 14.64
- Global, days
- 90
- Region
- Hand
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 7 cited references ↓
- Identify the specific CMC joint(s) treated by finger ray (e.g., ring finger CMC, small finger CMC) — thumb CMC dislocations are a different code family
- Confirm the dislocation was reduced by manipulation before or during pin placement — the descriptor requires manipulation
- Document K-wire or pin placement technique and fluoroscopic confirmation of reduction and fixation
- Record anesthesia type; anesthesia use distinguishes 26676 from 26670 (no anesthesia) and 26675 (requires anesthesia but no pinning)
- If billing multiple units (multiple joints), the operative note must describe each joint separately with its own reduction and fixation steps
- Note any associated fracture-dislocation components; a concurrent metacarpal fracture may require a separate code with modifier 59/XS
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 7 cited references ↓
CPT 26676 covers percutaneous skeletal fixation of a carpometacarpal (CMC) dislocation — fingers 2 through 5, not the thumb — where the surgeon manually reduces the dislocated joint and drives K-wires through the skin to hold the reduction. Fluoroscopic confirmation of pin placement is integral to the procedure and is not separately reportable. The descriptor specifies 'each joint,' so multiple dislocated CMC joints on the same hand can each support a unit of service — but document each joint distinctly in the operative note.
This code sits in the middle of the CMC dislocation hierarchy: 26670 and 26675 are closed treatment without pinning (without and with anesthesia, respectively), 26676 adds percutaneous fixation, and 26685/26686 are open treatments. Choosing the wrong level — billing 26675 when pins were placed — is a common upcoding flag. The 90-day global period covers all routine post-op management, pin-removal visits, and cast changes through day 90. Bill modifier 24 for unrelated E/M visits and modifier 78 if the patient returns to the OR for a related complication during the global.
The thumb CMC dislocation (Bennett fracture) is a separate code family (26650/26665). Document explicitly that the treated joint is the index, long, ring, or small finger CMC — not the thumb — to prevent downcoding or denial based on ambiguous anatomical language.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 5.6 |
| Practice expense RVU | 7.97 |
| Malpractice RVU | 1.07 |
| Total RVU | 14.64 |
| Medicare national rate | $488.99 |
| 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 | $488.99 |
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 26676 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Fluoroscopy billed separately — it is integral to percutaneous pin fixation and not independently payable
- Thumb CMC submitted under 26676 — the thumb requires 26650 or 26665; payers will deny or downcode
- Multiple units billed without per-joint documentation — each unit must correspond to a separately described joint reduction and fixation
- Closed treatment code (26675) submitted when operative note describes pin placement — mismatched procedure level triggers medical necessity denial
- Post-op E/M or cast removal billed without modifier 24 during the 90-day global period
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 7 cited references ↓
01Can 26676 be billed for two CMC joints dislocated on the same hand in the same session?
02Is fluoroscopy separately billable with 26676?
03What is the global period for 26676, and what does it include?
04How does 26676 differ from 26675, and why does it matter for billing?
05Can 26676 and a metacarpal fracture code be billed together if there is a fracture-dislocation?
06Is 26676 ever appropriate for the thumb CMC joint?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02vsac.nlm.nih.govhttps://vsac.nlm.nih.gov/context/cs/codesystem/CPT/version/2018/code/26676/info
- 03abos.orghttps://www.abos.org/wp-content/uploads/2019/12/hand-cpt-updated.pdf
- 04cms.govhttps://www.cms.gov/files/document/04-chapter4-ncci-medicare-policy-manual-2025finalcleanpdf.pdf
- 05cms.govhttps://www.cms.gov/medicare/coding-billing/national-correct-coding-initiative-ncci-edits
- 06bedrockbilling.comhttps://bedrockbilling.com/static/cci/26676
- 07eatonhand.comhttps://www.eatonhand.com/coding/n26676.htm
Mira AI Scribe
Mira's AI scribe captures the specific CMC joint treated (finger ray, laterality), the manipulation technique, K-wire gauge and entry points, fluoroscopic confirmation of reduction, and whether anesthesia was required. That detail anchors the 26676 level of service — distinguishing it from 26675 (no pinning) — and prevents downcoding on audit.
See how Mira captures CPT 26676 documentation