Closed treatment of an articular finger fracture at a metacarpophalangeal or interphalangeal joint, performed with manipulation to reduce the fracture fragment.

Verified May 8, 2026 · 6 sources ↓

Medicare: $422.19
Work RVU: 3.89
Global, days: 90
Region: Hand

Drawn from AAPCCMSBedrockbillingAAOS

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Identify the specific finger and joint involved (e.g., right index PIP, left ring MCP) — laterality and level are required for accurate ICD-10-CM coding.
Confirm the fracture is articular — document that the fracture line extends into the joint surface, distinguishing this from extra-articular fractures.
Document that manipulation was performed and describe the technique used to achieve reduction.
Record pre- and post-reduction alignment, including any imaging used to confirm reduction (fluoroscopy or plain film).
Describe the immobilization applied post-reduction (buddy taping, static splint, cast) and the position of immobilization.
Note neurovascular status of the digit before and after manipulation.
If multiple fingers are treated, document each fracture and its treatment separately to support multiple units of 26742.

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 57 Decision for surgery 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

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 26742 covers closed reduction of an articular fracture involving a finger joint — either a metacarpophalangeal (MCP) or interphalangeal (PIP/DIP) joint — where manipulation is required to achieve alignment. The 'articular' designation is the critical distinction: the fracture line enters the joint surface, which elevates both the clinical complexity and the coding specificity compared to extra-articular finger fractures treated without manipulation.

This code carries a 90-day global period. All routine follow-up, casting checks, and splint changes through day 90 are included in the base payment. A separately billable E/M during that window requires modifier 24 (unrelated) or modifier 25 (significant and separately identifiable on the day of service). If the decision for surgery — meaning a planned operative intervention — is made at the same encounter, append modifier 57 to the E/M.

Billing 26742 per finger is correct when multiple articular finger fractures are treated at the same session; each treated joint is a separate unit. NCCI edits govern what can be reported alongside this code — per the CMS NCCI 2026 Policy Manual, a cast or splint applied after treatment does not generate a separate supply or application code in the same anatomic area.

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 (3.89) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (12.64) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	3.89
Practice expense RVU	7.95
Malpractice RVU	0.8
Total RVU	12.64
Medicare national rate	$422.19
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	$422.19
HOPD (APC 5112) Hospital outpatient department	$1,642.82
ASC (PI A2) Ambulatory surgical center (freestanding)	$872.87

Common denial reasons

The recurring reasons claims for CPT 26742 get rejected.

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

Missing laterality or digit-level specificity in the ICD-10-CM code, causing a CPT-diagnosis mismatch that triggers an edit.
Coding 26742 when no manipulation was performed — closed treatment without manipulation maps to a different code family and auditors flag the discrepancy.
Billing a separate splint or casting application code for immobilization applied immediately after fracture reduction in the same anatomic area, which NCCI bundles into 26742.
Unbundling an E/M billed on the same day without modifier 25, when the evaluation was the pre-procedure assessment and not a separately identifiable service.
Reporting 26742 with an extra-articular fracture diagnosis — the ICD-10-CM code must reflect an intra-articular (articular surface) fracture to support the code.

Frequently asked questions

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

01Can I bill 26742 for each finger treated when multiple articular fractures are reduced in the same session?

Yes. Each finger joint treated with closed manipulation is a separate reportable unit. Bill 26742 with modifier 51 on subsequent units and document each fracture and reduction individually in the operative note.

02What is the global period for 26742 and what does it include?

26742 carries a 90-day global period. Routine post-op visits, dressing changes, splint and cast checks, and suture or staple removal through day 90 are all included. Unrelated visits in that window need modifier 24 on the E/M code.

03Can I separately bill for the splint applied after reduction?

No. Per CMS NCCI policy, casting, strapping, or splint application in the same anatomic area following fracture treatment is bundled into the fracture care code and cannot be billed separately.

04What is the ICD-10-CM specificity required to support 26742?

You need an intra-articular fracture code that specifies the correct finger, phalanx level or metacarpal head, laterality, and episode of care (initial = A). A non-articular fracture diagnosis will not support this code and will trigger a mismatch edit.

05When should I use modifier 22 with 26742?

Append modifier 22 when the manipulation required substantially more work than typical — for example, severe comminution, swelling requiring repeated attempts, or an unstable fracture pattern requiring extended fluoroscopic guidance. The operative note must explicitly describe why the work exceeded the norm.

06How does 26742 differ from 26740 and 26746?

26740 covers closed treatment of an articular finger fracture without manipulation. 26742 requires manipulation. 26746 is open treatment. The selection depends entirely on what was actually performed — code to the procedure documented, not the planned approach.

07If the fracture fails closed treatment and the patient returns for open fixation within the global period, what modifier applies?

Use modifier 58 if the open procedure was planned or staged, or modifier 78 if it was an unplanned return to the OR for a complication or failure of the closed reduction. Modifier 78 does not reset the global period; modifier 58 does.

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 specific finger, joint level (MCP, PIP, or DIP), side, confirmation that the fracture is articular, the manipulation technique, post-reduction alignment findings, imaging used, and the immobilization applied. That documentation directly supports the articular designation required to distinguish 26742 from non-articular or non-manipulation codes — preventing downcoding on audit or during payer review.

See how Mira captures CPT 26742 documentation