Closed treatment of a distal phalangeal fracture of a finger or thumb, performed with manipulation to restore alignment.

Verified May 8, 2026 · 5 sources ↓

Medicare: $381.10
Total RVUs: 11.41
Global, days: 90
Region: Hand

Drawn from CMSAAPCAcepAMA

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 digit treated and laterality (right/left hand, which finger or thumb)
Document the mechanism of injury and fracture pattern (displaced, non-displaced, tuft, shaft)
Describe the manipulation technique performed and the pre- and post-reduction alignment confirmed by imaging
Confirm closed treatment — note that the fracture site was not surgically opened
Record the post-reduction immobilization method applied (splint type, buddy taping)
Include the radiographic findings that confirmed fracture and post-manipulation positioning

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

26755 covers closed reduction of a distal phalanx fracture — finger or thumb — where the treating provider manually manipulates the fragment to achieve acceptable alignment without surgically opening the fracture site. The distal phalanx is most commonly fractured via crush injuries, door-slam mechanisms, or tuft injuries, and manipulation distinguishes this code from its without-manipulation counterpart (26750).

The 90-day global period means the initial manipulation, all routine follow-up visits, splint checks, and suture/staple removal through day 90 are bundled. Bill unrelated E/M services during that window with modifier 24. If a subsequent re-reduction is required by the same provider, append modifier 76. If a different provider performs re-reduction, use modifier 77. When care is split — for example, an ED physician performs the initial reduction but will not provide follow-up — append modifier 54 to communicate that surgical care only was rendered.

When multiple fingers on the same hand are treated in the same session, bill 26755 once per finger using the appropriate digit modifier (F1–F9, FA). Percutaneous pin fixation of a distal phalanx fracture steps up to 26756, not 26755. Open treatment with internal fixation maps to 26765. Selecting the wrong code within this family is a common audit trigger.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	3.15
Practice expense RVU	7.58
Malpractice RVU	0.68
Total RVU	11.41
Medicare national rate	$381.10
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	$381.10
HOPD (APC 5111) Hospital outpatient department	$252.01
ASC (PI G2) Ambulatory surgical center (freestanding)	$135.54

Common denial reasons

The recurring reasons claims for CPT 26755 get rejected.

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

Wrong code selected — 26756 (percutaneous fixation) or 26765 (open treatment) billed when closed reduction was performed
Missing digit modifier when multiple fingers on the same hand were treated same-day
Routine follow-up E/M billed without modifier 24 during the 90-day global period
Fracture care code billed when only an E/M with splint application was performed (no manipulation documented)
ICD-10 laterality or digit specificity mismatch between the diagnosis code and the digit modifier appended to 26755

Frequently asked questions

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

01What separates 26755 from 26750?

Manipulation. 26750 is closed treatment without manipulation — essentially immobilization only. 26755 requires that the provider actively reduced the fracture. If your note doesn't document a manipulation or reduction maneuver, 26750 is the correct code.

02How do you bill when three fingers on the same hand are treated at the same session?

Bill 26755 three times, each with the appropriate digit modifier (e.g., F7, F8, F9 for ring, little, and another digit). Append modifier 51 on the second and third lines to indicate multiple procedures. Each unit requires its own documentation of manipulation and post-reduction status.

03An ED physician reduces the fracture but the patient will follow up with an orthopedist. How does each provider bill?

The ED physician bills 26755 with modifier 54 (surgical care only). The orthopedist bills 26755 with modifier 55 (postoperative management only) and documents the transfer of care. Both providers must coordinate and ensure the global period is not double-billed.

04When does a distal phalanx fracture step up to 26756?

When percutaneous pin or wire fixation is placed across the fracture site — typically with imaging guidance — without surgically opening the fracture. If you're placing a K-wire percutaneously, 26756 is correct. 26755 is strictly closed manual reduction without any fixation hardware.

05Can 26755 be billed same-day as an E/M visit?

Yes, with modifier 25 on the E/M to document a significant, separately identifiable evaluation beyond the decision to treat the fracture. The E/M note must stand on its own — don't rely on the fracture care note to justify it.

06Does the 90-day global period apply even when treatment is provided in the ED?

Yes. The 90-day global is attached to the procedure code regardless of site of service. Any provider billing routine follow-up services within that 90-day window must append the appropriate modifier or risk a bundling denial.

Sources & references

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

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Mira's AI scribe captures the specific digit treated, laterality, fracture pattern, manipulation technique, post-reduction imaging confirmation, and immobilization method from your dictation. That detail directly populates digit modifiers and ICD-10 specificity, preventing the laterality mismatches and missing-modifier denials that are the most common rejection pattern for this code family.

See how Mira captures CPT 26755 documentation