Closed treatment of a proximal or middle phalangeal shaft fracture of a finger or thumb, performed without manipulation — billed per finger treated.
Verified May 8, 2026 · 5 sources ↓
- Medicare
- $235.48
- Total RVUs
- 7.05
- 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 5 cited references ↓
- Identify the specific finger(s) affected and the phalanx level (proximal or middle) for each fracture
- Imaging report or direct reference confirming the fracture and confirming no displacement requiring manipulation
- Type of immobilization applied (splint, buddy tape, short arm cast) and the specific finger(s) immobilized
- Confirmation that no closed or open reduction was performed — distinguishes 26720 from 26725 or 26727
- For multi-finger fractures: document each digit individually to support per-finger billing under CPT rules or to justify modifier 59 if needed
- Post-reduction plan, weight-bearing or activity restrictions, and follow-up interval documented in the encounter note
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 5 cited references ↓
CPT 26720 covers non-manipulative closed treatment of a shaft fracture involving the proximal or middle phalanx of any finger or thumb. No reduction is performed — the fracture is managed with immobilization such as a splint, buddy taping, or cast. The 'each' language in the descriptor is operationally significant: under CPT rules, you can bill 26720 for each finger fractured, appending the appropriate digit modifier. Under NCCI rules (and payer contracts that adopt them), if a single cast or splint treats multiple closed fractures without manipulation, only one unit of 26720 is reportable regardless of finger count.
The 90-day global period bundles the initial cast or splint application — do not separately bill 29130 (static finger splint) or 29131 (dynamic finger splint) on the same date. That bundle applies from day one and is explicitly reinforced by NCCI. Any E/M on the same day requires modifier 25 if a separately identifiable service was provided before the fracture treatment decision.
For multi-finger fractures in non-Medicare patients, append F-series digit modifiers (F1–F9) to distinguish each finger when billing multiple units. For Medicare beneficiaries, apply NCCI's single-unit rule unless your documentation supports distinct anatomical sites that clearly justify modifier 59 — and even then, payer acceptance varies. Confirm the patient's coverage before determining your unit count.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 1.72 |
| Practice expense RVU | 4.97 |
| Malpractice RVU | 0.36 |
| Total RVU | 7.05 |
| Medicare national rate | $235.48 |
| 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 | $235.48 |
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 26720 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Billing 26720 with 29130 or 29131 on the same date — splint application is bundled into fracture care and will deny
- Reporting multiple units of 26720 for a Medicare patient when a single cast treated all fractures — NCCI limits to one unit
- Missing digit-level specificity in the operative or encounter note — auditors flag notes that say 'finger fracture' without identifying which phalanx and which digit
- Unbundling an E/M on the same date without modifier 25 when the E/M was the visit that led directly to the fracture treatment
- Using 26720 when the record documents manipulation or reduction — that maps to 26725 (with or without fixation) or 26727 (percutaneous fixation)
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 5 cited references ↓
01Can I bill 26720 four times if four fingers were fractured and treated with one cast?
02Is the splint or cast included in 26720, or can I bill it separately?
03What modifier do I use if I provide a separately identifiable E/M on the same day I treat the fracture?
04What is the difference between 26720 and 26725?
05Does the 90-day global period affect billing for follow-up visits?
06Which digit modifiers should I use when billing 26720 for multiple fingers on non-Medicare patients?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01kzanow.comhttps://www.kzanow.com/coding-coaches/non-manipulative-treatment-of-finger-fractures-one-code-or-four-codes
- 02aapc.comhttps://www.aapc.com/codes/coding-newsletters/my-pediatric-coding-alert/wondering-which-ncci-edits-to-adopt-fracturesplint-bundle-applies-to-all-payers-article
- 03cgsmedicare.comhttps://www.cgsmedicare.com/medicare_dynamic/j15/partb/ptpb/ptp.aspx
- 04CMS Physician Fee Schedule 2026
- 05eatonhand.comhttps://www.eatonhand.com/coding/n26720.htm
Mira AI Scribe
Mira's AI scribe captures the specific digit and phalanx level (proximal vs. middle), the fracture displacement status, the immobilization method applied, and the explicit statement that no manipulation was performed — all from dictation. That level of specificity prevents the two most common audit flags on 26720: missing phalanx identification and ambiguous documentation that could support upcoding to 26725.
See how Mira captures CPT 26720 documentation