Closed reduction of a metacarpophalangeal (MCP) joint dislocation at a single knuckle, performed with anesthesia.

Verified May 8, 2026 · 6 sources ↓

Medicare: $488.66
Work RVU: 4.27
Global, days: 90
Region: Hand

Drawn from CMSAAPCEmednyCgsmedicareMdclarity

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify which digit(s) and which MCP joint is dislocated (e.g., index finger MCP, right hand)
Document the clinical necessity for anesthesia — e.g., failed awake reduction attempt, severe guarding, or patient intolerance
Record the type of dislocation (dorsal vs. volar, simple vs. complex/irreducible)
Confirm post-reduction neurovascular status and joint stability assessment
Document pre- and post-reduction radiographs confirming dislocation and successful reduction
Note the anesthesia type used (regional block, procedural sedation, or general) and who administered it

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

50 Bilateral procedure 59 Distinct service 24 Unrelated E/M during global 25 Significant separate E/M 51 Multiple procedures 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 26705 reports closed treatment of a single metacarpophalangeal dislocation requiring anesthesia for manipulation. It is the anesthesia-required counterpart to 26700, which covers the same reduction without anesthesia. The anesthesia requirement distinguishes 26705 from its sibling code — document why anesthesia was necessary (e.g., patient inability to tolerate manipulation, muscle guarding preventing adequate reduction, complex dislocation pattern) or the claim is vulnerable to downcoding to 26700.

The 90-day global period includes the day-before visit, the procedure day, and all routine post-op care through day 90. Separate E/M visits within that window need modifier 24 (unrelated) or 25 (significant, separately identifiable same-day visit). New or worsening complications billed inside the global require modifier 78 if a related return procedure is performed, or 79 if unrelated.

Side-specific modifiers LT and RT identify which hand is treated. If bilateral MCP dislocations are reduced at the same session, append modifier 50 to a single line. For multiple MCP joints on the same hand reduced under the same anesthesia encounter, each additional joint is a separately coded service — confirm NCCI PTP edit status before stacking units.

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 (4.27) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (14.63) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	4.27
Practice expense RVU	9.45
Malpractice RVU	0.91
Total RVU	14.63
Medicare national rate	$488.66
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	$488.66
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 26705 get rejected.

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

Claim downcoded to 26700 when documentation fails to justify the need for anesthesia
Missing laterality — no LT or RT modifier causes payer edits or requests for additional documentation
Global period conflict — post-op E/M billed without modifier 24 or 25 denied as bundled into the 90-day global
ICD-10 mismatch — dislocation diagnosis code does not specify laterality or the correct finger, triggering medical necessity denial
Multiple units billed for bilateral procedure without modifier 50, or without separate line items per payer preference

Frequently asked questions

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

01What separates 26705 from 26700?

Anesthesia. Both codes cover closed manipulation of a single MCP dislocation, but 26705 is used when anesthesia is required. Document why — failed awake attempt, severe guarding, or complex dislocation — or expect a downcode to 26700.

02Do I need LT or RT on this code?

Yes. Most payers require laterality modifiers on hand codes. Missing LT or RT is a common clean-claim failure. Bill LT or RT on every claim for 26705.

03Can I bill 26705 for multiple fingers on the same hand at the same session?

Each MCP joint dislocation is a separately reportable service. For a second digit on the same hand, bill an additional unit or a separate line with modifier 59 or XS, and verify NCCI PTP edit status before stacking. Bilateral same-hand dislocations of different fingers are not a modifier 50 scenario — 50 applies when the same joint is treated on both hands.

04What is the global period and what does it include?

26705 carries a 90-day global period. It covers the day-before visit, the procedure day, and all routine follow-up care through day 90 including cast checks, dressing changes, and suture removal. Unrelated E/M visits within that window need modifier 24; a significant same-day separate E/M needs modifier 25.

05How do I bill a return to the OR for a complication within the 90-day global?

If the return procedure is related to the original dislocation reduction — for example, addressing a failed reduction or instability — use modifier 78. If the return is for an entirely unrelated condition, use modifier 79. Do not invert these.

06Can the surgeon bill separately for the anesthesia on 26705?

If the operating surgeon personally provides regional or general anesthesia (not local), modifier 47 may apply per some state Medicaid policies, but this is rarely applicable in practice since anesthesia is almost always provided by a separate anesthesia provider who bills independently. Confirm payer policy before appending 47.

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 MCP joint involved, the treating digit, laterality, the reason anesthesia was required, dislocation type, reduction technique, and post-reduction neurovascular and stability findings from dictation. That detail prevents the most common denial on this code: downcoding to 26700 because the chart didn't justify why anesthesia was necessary.

See how Mira captures CPT 26705 documentation