Open treatment of an articular fracture at a metacarpophalangeal or interphalangeal joint, with or without internal fixation such as pins, wires, or screws.

Verified May 8, 2026 · 7 sources ↓

Medicare: $688.39
Work RVU: 9.56
Global, days: 90
Region: Hand

Drawn from CMSAAPCKzanowAaomsEatonhand

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Specify the exact joint involved: MCP, PIP, or DIP — and which finger by name or digit modifier.
Confirm fracture type (intra-articular) and displacement status with pre-op imaging citation in the operative note.
Document the open approach explicitly — incision location, fracture visualization, and reduction technique.
Name all fixation implants used (e.g., 0.045 K-wire, cortical screw) with size and number if placed.
When billing multiple digits, document each fracture site and fixation independently to support per-finger reporting.
If modifier 22 is appended, include a narrative quantifying extra work: additional time, complexity of comminution, or revision of fixation construct.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 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 7 cited references ↓

CPT 26746 covers open surgical treatment of an intra-articular finger fracture involving the metacarpophalangeal (MCP) or interphalangeal (PIP/DIP) joint. The surgeon opens the fracture site, reduces the joint surface, and may stabilize the construct with internal fixation — K-wires, pins, or screws. Confirmation imaging (X-ray) is part of the procedure. This is a 90-day global code, so routine post-op visits, dressings, and hardware checks through day 90 are bundled.

The descriptor says 'each,' which matters when multiple articular fractures are treated in the same session. Under CPT rules, report 26746 per finger with the appropriate digit modifier (F1–FA). Medicare/NCCI rules diverge from CPT rules for closed treatment bundled under a single cast, but open surgical treatment of distinct joints is separately reportable — document each fracture site and fixation method individually.

Fixation hardware removal within the 90-day global requires modifier 58 if planned at the time of the original procedure. Post-operative radiographs are not part of the global package and are separately billable. If the complexity significantly exceeded the typical procedure — for example, severely comminuted intra-articular fragments requiring extended reduction time — modifier 22 applies with a supporting operative narrative.

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 (9.56) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (20.61) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	9.56
Practice expense RVU	9.23
Malpractice RVU	1.82
Total RVU	20.61
Medicare national rate	$688.39
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	$688.39
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 26746 get rejected.

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

Missing laterality or digit modifier — payers require finger-level specificity (F1–FA) to adjudicate multiple same-session claims.
Operative note describes 'standard approach' without naming the incision or confirming open fracture visualization, triggering a downcoded or denied claim.
Multiple 26746 units bundled without NCCI modifier 59 or XS when treating separate digits in the same session.
Hardware removal billed within the 90-day global without modifier 58, causing denial as a bundled post-op service.
Diagnosis code does not match an intra-articular fracture — shaft-only fractures (e.g., proximal phalanx shaft) belong under different CPT codes in the 26720-range.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01Can I bill 26746 on multiple fingers in the same operative session?

Yes, under CPT rules 26746 is an 'each' code. Bill one unit per finger with the appropriate digit modifier (F1–FA). Append modifier 51 on secondary lines and modifier 59 or XS if NCCI edits fire. Document each fracture site and fixation construct separately in the operative note.

02What's the difference between 26746 and 26742?

26742 is closed treatment of an articular fracture with manipulation — no incision. 26746 is open treatment requiring a surgical incision and direct visualization of the joint surface. If your operative note documents an incision, 26746 is correct regardless of whether fixation was placed.

03Do I need modifier 58 to bill hardware removal after 26746?

Yes, if hardware removal (e.g., K-wire pull) falls within the 90-day global and was planned at or before the original procedure, append modifier 58. Unplanned return to the OR for a related complication uses modifier 78 instead.

04Are post-operative X-rays included in the 26746 global period?

No. Post-operative radiographs are not part of the 90-day global package for fracture care. Bill them separately with the appropriate imaging CPT code and modifier 79 is not needed — they're outside the global by CMS definition.

05When does modifier 22 apply to 26746?

Use modifier 22 when the procedure required substantially more work than the typical intra-articular open reduction — for example, severe comminution requiring stepwise fragment reassembly, prolonged fluoroscopic guidance, or revision of failed fixation construct. The operative note must quantify the extra effort; a vague 'complex case' notation won't survive audit.

06Which ICD-10 codes pair with 26746?

Use displaced intra-articular fracture codes at the specific digit and phalanx level from the S62.6xx range (middle/proximal phalanx) or S62.3xx–S62.5xx range for metacarpal head or base fractures involving the joint. The 7th character must be 'A' for the initial encounter on the operative claim. Shaft-only fracture codes do not support 26746 — they point to the 26720-range codes.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the joint level (MCP, PIP, or DIP), laterality, digit name, fracture type (intra-articular, displaced, comminuted), surgical approach, reduction method, and all fixation hardware placed. That specificity prevents the two most common 26746 denials: missing digit-level documentation and operative notes that don't confirm the fracture was surgically opened and visualized.

See how Mira captures CPT 26746 documentation