Percutaneous fixation of an unstable phalangeal shaft fracture of a finger or thumb, involving manipulation to reduce the fracture followed by placement of pins, wires, or screws through the skin without open incision.

Verified May 8, 2026 · 4 sources ↓

Medicare: $456.92
Work RVU: 5.28
Global, days: 90
Region: Hand

Drawn from CMSAAPC

Documentation requirements

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

Source · Editorial brief grounded in 4 cited references ↓

Radiographic or clinical evidence of fracture instability justifying percutaneous fixation rather than closed treatment alone
Identification of the specific digit and phalanx involved (proximal vs. middle), using finger-level specificity
Description of the reduction maneuver performed prior to hardware placement
Type, number, and placement of fixation hardware (K-wires, pins, screws) documented in the operative note
Pre- and post-reduction imaging confirming alignment, or documentation explaining why intraoperative imaging was used
If multiple digits treated, separate documentation for each fracture site to support multiple units with modifier 51

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 52 Reduced services 58 Staged or related 59 Distinct service 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 4 cited references ↓

CPT 26727 covers closed reduction with percutaneous fixation of an unstable phalangeal shaft fracture involving the proximal or middle phalanx of a finger or thumb. The surgeon first manipulates the fracture to achieve anatomic or near-anatomic alignment, then stabilizes it with hardware — typically Kirschner wires, pins, or screws — driven through the skin rather than through an open wound. This distinguishes 26727 from open treatment (26735) and from simple closed treatment without fixation (26725).

The 90-day global period means all routine follow-up, pin-site wound checks, and cast or splint changes are bundled through day 90. Pin removal performed during the global period is also included and cannot be billed separately unless it occurs under anesthesia, in which case 20670 or 20680 may be reportable with modifier 78 if planned as a staged procedure or modifier 79 if unrelated. When multiple fingers are treated at the same operative session, bill 26727 for each finger with modifier 51 on secondary codes and digit-specific finger modifiers (F1–F9, FA) to identify each site.

Documentation must establish instability — the clinical or radiographic finding that drove the choice of percutaneous fixation over closed treatment alone. Operative notes that fail to distinguish instability from a stable fracture, or that describe the approach without naming hardware type and placement site, are the leading audit trigger for this code.

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 (5.28) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (13.68) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	5.28
Practice expense RVU	7.36
Malpractice RVU	1.04
Total RVU	13.68
Medicare national rate	$456.92
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	$456.92
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 26727 get rejected.

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

Operative note describes a stable fracture without establishing instability, triggering downcode to 26725
Multiple digits billed without finger-specific modifiers (FA, F1–F9), causing duplicate service edits
Pin removal billed separately during the 90-day global without a valid modifier or documentation of anesthesia
Lack of pre-reduction imaging or documentation of manipulation, suggesting fixation without reduction attempt
26727 billed same-day as 26735 on the same digit without modifier 59 or XS establishing a distinct site

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 4 cited references ↓

01What makes a phalangeal fracture 'unstable' for 26727 billing purposes?

Document the specific instability finding: apex volar or dorsal angulation beyond acceptable thresholds, rotational malalignment, oblique or spiral fracture pattern that won't hold closed reduction, or loss of reduction on stress testing. The operative note needs to state this explicitly — 'fracture unstable, unable to maintain reduction without fixation' — not just imply it from the choice of treatment.

02Can I bill 26727 for each finger when treating multiple fractures in one operative session?

Yes. 26727 is billed per finger. Apply modifier 51 to each additional code beyond the primary, and add finger-level modifiers (FA for thumb, F1–F9 for other digits) to every line. Each digit needs its own documentation of instability and fixation.

03Can pin removal be billed separately during the 90-day global?

Not for a simple office removal — that's bundled into the global. If removal requires a return to the OR under anesthesia, bill 20670 (superficial) or 20680 (deep) with modifier 78 if it was a planned staged removal, or modifier 79 if unrelated to the original fracture management.

04What's the difference between 26727 and 26725, and how do auditors distinguish them?

26725 is closed treatment without fixation — manipulation only. 26727 requires percutaneous hardware. Auditors look for operative notes that mention pin placement but lack any pre-hardware reduction attempt or instability finding. If the note describes a stable fracture that was simply pinned for convenience, expect a downcode challenge.

05If I perform 26727 and 26735 on different digits in the same session, is modifier 59 needed?

Yes. Bill each code with the appropriate digit modifier (FA, F1–F9) to establish distinct anatomic sites, and add modifier 59 or XS to the secondary procedure to override any NCCI bundling edits. The separate-site documentation must be in the operative note — different digit, different phalanx, different hardware.

06Is fluoroscopic guidance separately billable with 26727?

No. Intraoperative fluoroscopy used to guide reduction and pin placement in fracture fixation is not separately reportable — it's considered integral to the procedure. The NCCI policy manual bars separate reporting of radiologic guidance when its use is inherent to the primary procedure.

Sources & references

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

01CMS Physician Fee Schedule 2026
02
cms.gov
https://www.cms.gov/files/document/04-chapter4-ncci-medicare-policy-manual-2026-final.pdf
03
aapc.com
https://www.aapc.com/codes/cpt-codes/26727
04
cms.gov
https://www.cms.gov/regulations-and-guidance/guidance/transmittals/downloads/r3674cp.pdf

Mira AI Scribe

Mira's AI scribe captures the instability finding (angulation, rotational deformity, or inability to hold reduction), the specific digit and phalanx, the reduction maneuver performed, and the hardware type and quantity placed percutaneously. This prevents the most common downcode trigger — operative notes that describe pin placement without documenting why closed treatment alone was insufficient.

See how Mira captures CPT 26727 documentation