Open surgical treatment of a proximal or middle phalangeal shaft fracture of a finger or thumb, with internal fixation when performed — billed per finger.

Verified May 8, 2026 · 6 sources ↓

Medicare: $564.48
Total RVUs: 16.9
Global, days: 90
Region: Hand

Drawn from CMSAAPCPayerpriceFindacodeAAOS

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 phalanx was fractured (proximal or middle) and which digit, including laterality (left/right and finger identifier)
Operative note must state 'open treatment' with direct visualization of the fracture site — notes that only say 'standard approach' or omit approach details flag on audit
Document whether internal fixation was used and, if so, the type and placement (K-wire, screw, plate)
Fracture characterization: displaced vs. non-displaced, comminuted, open vs. closed injury — supports medical necessity for open reduction
Pre-operative imaging confirming phalangeal shaft fracture of the proximal or middle phalanx (not distal, not articular)
Post-operative plan and follow-up instructions to support global period management

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 52 Reduced services 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

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 26735 covers open reduction of a phalangeal shaft fracture involving the proximal or middle phalanx of any finger or thumb. 'Open treatment' means the surgeon directly visualizes the fracture site through surgical exposure — this is not a closed or percutaneous approach. Internal fixation (K-wires, screws, plates) is included in the code when performed; you do not unbundle it separately. The code is reported per digit treated.

This code sits within the 26720–26765 finger fracture family. Know the distinctions: 26725 is closed without manipulation, 26727 is percutaneous fixation with manipulation, and 26735 is the open treatment code for shaft fractures of the proximal or middle phalanx. For distal phalangeal shaft fractures treated open, use 26765. For articular fractures treated open at the MCP or IP joint, use 26746. Selecting the wrong code in this family is one of the most common audit triggers for hand fracture billing.

The 90-day global period applies. All routine post-op visits, dressing changes, and hardware monitoring through day 90 are bundled. Services unrelated to the fracture care during that window require modifier 24. A new, distinct injury or procedure in the global period requires modifier 79. Digit-specific modifiers (F1–F9) are used by many payers to identify which finger was treated — confirm requirements with each payer, as some mandate them for bilateral or multi-digit claims.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	7.23
Practice expense RVU	8.27
Malpractice RVU	1.4
Total RVU	16.9
Medicare national rate	$564.48
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	$564.48
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 26735 get rejected.

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

Wrong code selected — distal phalangeal fractures billed under 26735 instead of 26765, or articular fractures billed here instead of 26746
Missing digit-specific modifier (F1–F9) when the payer requires laterality and digit identification for hand fracture codes
Unbundling internal fixation hardware or fluoroscopy as separate line items when they are included in the 26735 global package
Lack of documentation distinguishing open treatment from percutaneous fixation (26727) — operative notes that don't clearly state direct visualization of the fracture site
Global period conflicts: follow-up visits billed without modifier 24 or 79 during the 90-day global window

Frequently asked questions

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

01Is internal fixation separately billable when performed with 26735?

No. Internal fixation is included in 26735 when performed. Do not unbundle K-wire placement or screw fixation as a separate line item — it will be denied as included in the primary procedure.

02Which digit modifiers should I use with 26735?

Use HCPCS digit modifiers F1–F9 to identify the specific finger treated. Many payers require these for hand fracture codes, especially when billing multiple digits or bilateral procedures. Confirm requirements payer by payer — Medicare does not mandate them but many commercial payers do.

03Can I bill 26735 for a distal phalangeal fracture treated open?

No. 26735 covers the proximal and middle phalanx only. Open treatment of a distal phalangeal shaft fracture is reported with 26765. Using 26735 for a distal fracture is a miscode and an audit risk.

04What is the global period for 26735, and what does it include?

26735 carries a 90-day global period. Routine post-op visits, wound checks, dressing changes, and hardware monitoring through day 90 are all bundled. Bill unrelated services with modifier 24; a new distinct injury or unrelated procedure in the global window requires modifier 79.

05How do I bill if I treat fractures on two fingers in the same session?

Report 26735 for each digit treated. List the highest-RVU procedure first, append modifier 51 to the second and subsequent codes, and use the appropriate digit modifiers (F1–F9) to distinguish which finger each code covers. Confirm payer rules on multi-digit billing before submitting.

06What distinguishes 26735 from 26727?

26727 is percutaneous skeletal fixation with manipulation — no open surgical exposure of the fracture site. 26735 requires direct visualization of the fracture through surgical exposure. The operative note must make this distinction explicit; if it doesn't, expect downcoding or a request for records.

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 fracture location (proximal vs. middle phalanx), digit and laterality, surgical approach, direct fracture site visualization, fixation method and hardware used, and reduction technique from dictation. That specificity prevents the most common denial for this code family: op notes that don't distinguish 26735 open treatment from 26727 percutaneous fixation, or that fail to confirm which phalanx was treated.

See how Mira captures CPT 26735 documentation