Percutaneous skeletal fixation of a single metacarpophalangeal (MCP) joint dislocation, performed with manipulation.

Verified May 8, 2026 · 6 sources ↓

Medicare: $418.18
Work RVU: 5.18
Global, days: 90
Region: Hand

Drawn from CMSBeonbrandAbosFastrvuAAPC

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify the digit(s) involved by name or number (e.g., index finger, long finger, ring finger) — 'finger' alone is insufficient.
Document the joint level as MCP (metacarpophalangeal); phalangeal joint dislocations use different codes.
Confirm single-joint involvement — 26706 covers one joint; multiple dislocations require separate coding with modifier 59 or XS if clinically distinct.
Describe the percutaneous fixation technique: hardware type (K-wire, screw), number of pins, and insertion approach.
Record that closed manipulation was performed as part of the same operative session.
Document laterality (left vs. right hand) to support LT/RT modifier usage and payer-specific requirements.
Note anesthesia type used — this helps distinguish from 26700 (no anesthesia) and 26705 (anesthesia, no fixation).
Fluoroscopic guidance use should be documented if billed separately, with distinct medical necessity stated.

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 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 XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 26706 covers percutaneous pin fixation of a dislocated MCP joint — the knuckle where the finger meets the hand — performed with closed manipulation. The surgeon reduces the dislocation and stabilizes the joint using K-wires, screws, or similar hardware introduced through the skin without a formal open incision. This distinguishes 26706 from 26700 (closed treatment without anesthesia) and 26705 (closed treatment requiring anesthesia), neither of which includes skeletal fixation, and from 26715, which is open treatment with internal fixation.

26706 carries a 90-day global period. All routine follow-up care, pin checks, and dressing changes through day 90 are bundled. Hardware removal within the global window requires modifier 78 if it's a return to the OR for a related complication, or modifier 58 if it's a planned staged procedure. NCCI bundles 26706 with finger arthroscopy codes 29900–29902; those combinations generally cannot be bypassed with a modifier.

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 (5.18) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (12.52) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	5.18
Practice expense RVU	6.45
Malpractice RVU	0.89
Total RVU	12.52
Medicare national rate	$418.18
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	$418.18
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 26706 get rejected.

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

Wrong code level: 26706 requires percutaneous fixation hardware; billing it when only manipulation was performed without pinning will trigger downcoding to 26705 or 26700.
NCCI bundle conflict: 26706 billed same-day with arthroscopy codes 29900–29902 will deny per NCCI; modifier cannot bypass this edit.
Lack of laterality documentation causing LT/RT modifier mismatch with the ICD-10 diagnosis code on the claim.
Global period violations: follow-up pin checks or dressing changes billed separately within the 90-day global without modifier 24 (unrelated E/M) will be denied.
Unspecified digit on the claim: payers and audit teams flag claims lacking a specific finger identified in both the operative note and diagnosis code.

Frequently asked questions

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

01What separates 26706 from 26705?

26705 is closed treatment of an MCP dislocation requiring anesthesia — no hardware is placed. 26706 requires percutaneous skeletal fixation (K-wire, pin, or screw) in addition to manipulation. If you reduced the dislocation under anesthesia but didn't place any hardware, 26705 is correct.

02Can I bill 26706 for two dislocated fingers on the same hand in the same session?

Yes. 26706 covers a single joint. For two separate MCP dislocations on the same hand, report 26706 twice with modifier 59 or XS to distinguish the separate anatomic sites. Document each digit and each fixation separately in the operative note.

03How do I bill hardware removal within the 90-day global period?

If hardware removal requires a return to the OR and is related to the original procedure (e.g., pin site complication), use modifier 78. If it's a planned staged removal that was anticipated at the time of the original surgery, use modifier 58. Do not bill hardware removal without one of these modifiers during the global period.

04Does 26706 bundle with fluoroscopy?

Intraoperative fluoroscopic guidance used during percutaneous pin placement is typically bundled into the surgical code by most payers. Check your specific payer's policy before billing a separate fluoroscopy code — many private payers follow NCCI bundling logic here.

05When is modifier 22 appropriate for 26706?

Modifier 22 applies when the procedure required substantially more work than typical — for example, a complex or irreducible dislocation requiring extensive manipulation, interposed soft tissue, or significantly prolonged operative time. Documentation must detail exactly why the case was atypically difficult. Expect payer scrutiny and a request for operative notes.

06Can 26706 be billed bilaterally with modifier 50?

Yes, if MCP dislocations on both hands are treated in the same session. Report 26706 with modifier 50. Some payers require two line items with LT and RT instead — confirm your payer's preference 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 specific digit, joint level (MCP), hardware type and pin count, laterality, and confirmation that closed manipulation accompanied fixation — all pulled directly from your dictation. This prevents the most common audit flag on 26706: operative notes that document manipulation but never explicitly confirm percutaneous hardware placement, which gives payers grounds to downcode to 26705.

See how Mira captures CPT 26706 documentation