Percutaneous skeletal fixation of a distal phalangeal fracture of a finger or thumb, performed through the skin without direct surgical exposure of the fracture site.

Verified May 8, 2026 · 5 sources ↓

Medicare: $414.84
Work RVU: 4.47
Global, days: 90
Region: Hand

Drawn from AAPCEmednyAaomsCgsmedicareCMS

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Specify which digit(s) treated — finger number and laterality (e.g., right ring finger distal phalanx)
Confirm percutaneous technique: hardware placed through skin without direct fracture exposure
Document fracture type: displaced vs. non-displaced, closed vs. open, articular vs. extra-articular
Record hardware used: Kirschner wire size, pin count, or screw type
Note fluoroscopy use and intraoperative imaging confirming reduction and fixation placement
Separate operative note section if debridement (11012) was performed at the same encounter
ICD-10-CM code to the highest specificity: laterality, finger, displacement status, and encounter type (A for initial, B for open fracture)

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 51 Multiple procedures 58 Staged or related 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 79 Unrelated during global LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 26756 describes percutaneous skeletal fixation of a distal phalanx fracture — finger or thumb, billed per digit. The surgeon stabilizes the fracture by inserting Kirschner wires, pins, or screws through the skin without surgically opening the fracture site. Fluoroscopic guidance is typically used to confirm fragment reduction and hardware placement. This technique sits between closed treatment (26755) and open treatment (26765) on the invasiveness spectrum — fracture fragments are not directly visualized, but fixation hardware crosses the fracture site.

The 90-day global period covers the surgery itself, the day-before visit, and all routine post-op care through day 90. Planned hardware removal during the global period requires modifier 58 to signal a staged procedure. Postoperative radiographs are not included in the global package and are separately billable. When an open wound requires debridement at the same encounter — common in crush or door-slam injuries — add 11012 separately with modifier 59 to document the distinct service.

For multi-digit injuries, 26756 is billed once per finger treated. Each digit gets its own line. If both hands are involved, modifier 50 applies. Laterality modifiers LT and RT are expected when a single digit is treated. Confirm NCCI edits when pairing with adjacent hand codes in the same session, as bundling rules may apply depending on the specific code combination.

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 (4.47) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (12.42) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	4.47
Practice expense RVU	7.08
Malpractice RVU	0.87
Total RVU	12.42
Medicare national rate	$414.84
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	$414.84
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 26756 get rejected.

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

Missing laterality — claim submitted without LT or RT when only one digit treated
Upcoded or miscoded technique — open fracture with surgical exposure billed as percutaneous (should be 26765)
Global period conflict — post-op visit billed without modifier 24 during the 90-day global window
Bundling denial when debridement (11012) is billed same-day without modifier 59 to establish distinct service
Multiple digits billed incorrectly — using modifier 51 instead of billing separate line items per digit
ICD-10-CM mismatch — diagnosis code reflects proximal or middle phalanx fracture rather than distal phalanx

Frequently asked questions

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

01Can 26756 be billed for multiple fingers in the same operative session?

Yes. Bill one unit of 26756 per digit treated, each on a separate line. Modifier 51 is used to flag additional procedures, but the key is separate line items — not multiple units on a single line.

02What is the difference between 26756 and 26765?

26756 is percutaneous — hardware placed through the skin, no direct surgical exposure of the fracture. 26765 is open treatment with internal fixation, where the surgeon directly visualizes the fracture site. Using 26756 when the op note describes an open approach is a common upcoding audit flag.

03When should modifier 58 be used with 26756?

Append modifier 58 when hardware removal is performed during the 90-day global period and was planned at the time of the original fixation. This signals a staged procedure rather than a complication, allowing separate payment.

04Is debridement separately billable when performed alongside 26756?

Yes. When open wound debridement (e.g., 11012) is performed at the same encounter — as is common with crush injuries or open fractures — bill it separately with modifier 59 to document it as a distinct service. The operative note must clearly describe both the fracture fixation and the debridement.

05Does 26756 require fluoroscopy to be billed separately?

Fluoroscopy used intraoperatively to guide pin placement is generally considered bundled into the procedure. Postoperative imaging, however, falls outside the global package and is separately billable with the appropriate radiology code.

06How do you handle 26756 when both hands are treated?

Use modifier 50 for a true bilateral procedure. If only specific digits on each hand are treated, LT and RT on separate lines may be more precise — confirm with your payer, as bilateral reporting rules vary for fracture care codes.

Sources & references

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

Mira Scribe

Mira's AI scribe captures digit identity, laterality, fracture displacement and type (closed vs. open), hardware specifics (wire gauge, pin count), and fluoroscopy use directly from surgeon dictation. It flags when the operative note describes direct fracture visualization — which would shift the code to 26765 — preventing a percutaneous code from being applied to what was actually an open procedure. For crush injuries, it also prompts debridement documentation to support add-on billing.

See how Mira captures CPT 26756 documentation