Fusion · Hand

Arthrodesis of a carpometacarpal joint of the hand, any digit except the thumb, with or without internal fixation

Verified May 8, 2026 · 6 sources ↓

Medicare: $769.56
Total RVUs: 23.04
Global, days: 90
Region: Hand

Drawn from CMSAAPCAbosMdclarityFindacode

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 digit and CMC joint level was fused (e.g., ring finger CMC joint, index finger CMC joint)
State whether internal fixation was used and name the device type (K-wire, screw, plate)
Document whether bone graft was used; if so, identify donor site and justify use of 26843 vs. 26844
Include the clinical indication — diagnosis driving fusion (e.g., post-traumatic arthritis, CMC joint instability, OA grade)
Record intraoperative fluoroscopy use and whether it was included in the procedure or reported separately
Confirm laterality (left vs. right hand) in the operative note and on the claim

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 59 Distinct service 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 26843 covers surgical fusion of a non-thumb carpometacarpal (CMC) joint — the articulation where a finger's metacarpal meets the distal carpal row. The procedure stabilizes a painful or unstable CMC joint by promoting bony union, with or without hardware such as K-wires, screws, or plates. It is reported per joint fused; if multiple non-thumb CMC joints are fused in the same session, 26843 is listed for each with modifier 59 to distinguish separate levels.

When bone graft harvest is required to augment fusion, report 26844 instead of 26843. Using 26843 when autograft is harvested from a separate site — and not reporting the upgrade code — is an undercoding error that leaves reimbursement on the table. If the graft site is the iliac crest or another remote donor site, verify whether a separate harvest code applies or whether 26844 already bundles that work.

The code carries a 90-day global period. All routine post-op visits, hardware checks, dressing changes, and cast/splint applications are bundled through day 90. Separate E/M visits within the global require modifier 24 (unrelated condition) or, if on the day of surgery for a distinct problem, modifier 25 on the E/M. An unplanned return to the OR for a related complication — such as hardware failure or wound dehiscence — uses modifier 78.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	7.59
Practice expense RVU	13.83
Malpractice RVU	1.62
Total RVU	23.04
Medicare national rate	$769.56
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	$769.56
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI A2) Ambulatory surgical center (freestanding)	$3,695.53

Common denial reasons

The recurring reasons claims for CPT 26843 get rejected.

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

Missing laterality — claim submitted without LT or RT modifier, triggering edit or suspension
26843 billed when autograft was harvested; 26844 is the correct code when graft harvest is part of the procedure
Multiple CMC joint fusions reported without modifier 59 on each additional unit, causing NCCI bundling denial
Lack of medical necessity documentation — operative note does not connect diagnosis (ICD-10) to severity requiring fusion
Routine post-op visits billed without modifier 24 during the 90-day global period, resulting in automatic denial

Frequently asked questions

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

01What is the difference between 26843 and 26844?

26843 covers CMC joint fusion of a non-thumb digit with or without internal fixation, but without autograft harvest. 26844 is the correct code when autograft is harvested from a separate site as part of the same procedure. Billing 26843 when graft was harvested undercodes the encounter.

02Can 26843 be billed more than once if multiple CMC joints are fused?

Yes. 26843 is defined as 'each' joint. Report it for each non-thumb CMC joint fused in the same session, appending modifier 59 on the second and subsequent units to bypass NCCI bundling edits. List the highest-RVU procedure first.

03Does 26843 include fluoroscopy?

Intraoperative fluoroscopy is generally considered integral to joint fusion procedures and is not separately reportable. Do not add a fluoroscopy code unless payer-specific policy or a CPT manual instruction explicitly allows it for this code.

04How long is the global period for 26843, and what does it cover?

26843 carries a 90-day global period. That includes the procedure day, any same-day pre-op visit, and all routine post-op care through day 90 — visits, splint or cast changes, suture removal, and hardware checks. Bill modifier 24 for unrelated E/M visits inside the global.

05Which modifier applies if the patient returns to the OR for a hardware problem within the global?

Use modifier 78 for an unplanned return to the OR for a complication related to the original fusion, such as hardware failure or wound dehiscence. Modifier 79 is for a completely unrelated procedure during the post-op period — do not invert these.

06Is modifier 50 appropriate for bilateral CMC fusions?

Modifier 50 applies when the identical procedure is performed on the contralateral hand in the same session. For fusions of different digits on the same hand, use modifier 59 per additional joint — not modifier 50.

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 digit and CMC joint fused, fixation hardware used, graft decision (none, local, or autograft from named donor site), and laterality directly from dictation. That prevents the two most common claim edits: a missing LT/RT modifier and a 26843-vs-26844 mismatch when autograft harvest is buried in the narrative but not reflected on the claim.

See how Mira captures CPT 26843 documentation