Closed treatment of a phalangeal shaft fracture in the proximal or middle phalanx of a finger or thumb, requiring manipulation, with or without skin or skeletal traction, reported per finger.

Verified May 8, 2026 · 5 sources ↓

Medicare: $395.80
Total RVUs: 11.85
Global, days: 90
Region: Hand

Drawn from AAPCFindacodeCMS

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 phalanx fractured — proximal or middle — and the specific finger or thumb; operative note listing 'phalangeal fracture' without phalanx level is insufficient.
Confirm the fracture is a shaft fracture, not an articular fracture (which routes to 26742) and not a distal phalanx fracture (which routes to 26755).
Document that manipulation was performed to justify 26725 over 26720; describe the reduction technique and the post-reduction alignment achieved.
Record whether skin traction, skeletal traction, or neither was used — all are billable under 26725, but traction type must be noted to defend the code level.
Pre- and post-reduction imaging findings supporting displacement and the need for manipulation.
For multiple fingers, identify each fractured digit separately to support multiple units of 26725 with appropriate digit modifiers.

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 25 Significant separate E/M 51 Multiple procedures 52 Reduced services 58 Staged or related 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 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 5 cited references ↓

26725 covers closed reduction of a displaced phalangeal shaft fracture — proximal or middle phalanx, finger or thumb — where the surgeon manipulates the fracture to restore alignment without opening the fracture site. Skin or skeletal traction may be applied as part of the same procedure; that does not bump you to a higher code. The descriptor explicitly includes traction within this code. 'Closed' means the fracture site is never surgically opened — if it is, you're in open treatment territory.

The code is reported per finger. Two fingers on the same hand, same session, both requiring manipulation: bill 26725 twice, with modifier 59 (or XS) on the second unit to distinguish separate fracture sites. Do not use modifier 50 — bilateral finger coding uses digit-specific modifiers (F1–F9, FA) to identify each finger, not the 50 bilateral modifier, which is reserved for paired anatomical structures like limbs.

The 90-day global period means all routine follow-up care — splint checks, repeat X-rays read by the treating surgeon, cast changes, and stitch removal — is bundled through day 90. An E/M visit during the global for an unrelated problem needs modifier 24. If the fracture fails closed reduction and requires percutaneous pinning at a later session, bill 26727 with modifier 58 (staged or related procedure by the same physician).

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	3.39
Practice expense RVU	7.74
Malpractice RVU	0.72
Total RVU	11.85
Medicare national rate	$395.80
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	$395.80
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 26725 get rejected.

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

Billing 26725 for a distal phalanx shaft fracture — that is 26755 with manipulation; wrong anatomical level triggers a code-level denial.
Billing 26725 without documentation of manipulation — payers downcode to 26720 (no manipulation) when operative notes omit reduction technique.
Using modifier 50 for bilateral finger fractures instead of digit-specific modifiers (FA, F1–F9), causing claim rejection or overpayment recoupment.
Unbundling traction as a separate service — skin or skeletal traction is included in 26725 and cannot be billed separately on the same date.
Modifier 57 on a same-day E/M instead of modifier 25 — 26725 carries a 90-day global, so an E/M on the day of service requires modifier 25, not 57 (modifier 57 applies only to major surgeries with 90-day globals when the decision for surgery is made the day before or day of).

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01What separates 26725 from 26720?

Manipulation. 26720 is closed treatment without manipulation — buddy taping or splinting a non-displaced fracture. 26725 requires documented reduction of a displaced fracture. If your note doesn't describe the manipulation technique, expect a downcode to 26720.

02Can I bill 26725 and 26727 together if I attempted closed reduction and then placed a percutaneous pin in the same session?

No. If the same session escalates from attempted closed reduction to percutaneous fixation, bill only 26727 — it includes the manipulation. Billing both on the same date for the same fracture is an unbundling error.

03How do I bill two finger fractures requiring manipulation on the same hand?

Report 26725 twice, once per finger. Use digit-specific modifiers (e.g., F1 for left index, F2 for left middle) and modifier 59 or XS on the second line to indicate distinct fracture sites. Do not use modifier 50.

04If the fracture fails closed reduction and needs open surgery two weeks later, what modifier applies?

Modifier 58 — the open treatment (26735 or 26756 depending on location) is a staged or therapeutically related procedure performed during the global period of 26725 by the same surgeon.

05Does 26725 include post-reduction X-rays?

Imaging interpretation by the treating surgeon during the global period is generally bundled. If radiology reads the post-reduction film separately, they bill the radiology code. The surgeon's interpretation of images taken to confirm reduction is not separately billable during the same session.

06Is an articular phalanx fracture of the finger coded to 26725?

No. Articular fractures involving the metacarpophalangeal or interphalangeal joint route to 26742 (with manipulation). 26725 is strictly for shaft fractures of the proximal or middle phalanx — not joint-surface fractures.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira AI Scribe

Mira's AI scribe captures the phalanx level (proximal vs. middle), the specific digit, whether manipulation was performed, reduction technique used, post-reduction alignment, and traction type (skin, skeletal, or none) directly from the surgeon's dictation. That prevents downcoding to 26720 for missing manipulation documentation and eliminates audit flags from operative notes that identify only 'finger fracture' without specifying the phalangeal segment.

See how Mira captures CPT 26725 documentation