Fusion · Hand

Surgical fusion of an interphalangeal (IP) joint of a finger, with or without internal fixation hardware.

Verified May 8, 2026 · 6 sources ↓

Medicare: $606.56
Total RVUs: 18.16
Global, days: 90
Region: Hand

Drawn from CMSAAPCKzanowFastrvu

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 joint level was fused — DIP or PIP — and identify the exact finger using standard digit nomenclature (e.g., left ring finger DIP).
Document the fixation method used: Kirschner wire, headless compression screw, plate, or no hardware, as applicable.
Record the source of any bone graft — local reaming/allograft (26860) vs. separate harvest site (26862) — to justify code selection.
Operative note must name the surgical approach rather than stating 'standard approach'; audit teams flag generic approach language.
Document pre-op imaging and clinical findings confirming end-stage joint disease or deformity justifying arthrodesis over joint-preserving alternatives.
For multi-digit cases, the note must individually describe each joint fused to support billing 26861 add-on units with distinct digit modifiers.

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 58 Staged or related 59 Distinct service 62 Co-surgeons 74 Discontinued post-anesthesia 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 26860 covers arthrodesis of a single interphalangeal joint — DIP or PIP — of a finger, including placement of any internal fixation used to hold the joint in the fused position. The procedure eliminates motion at the joint to relieve pain, most commonly from end-stage osteoarthritis or post-traumatic deformity. Local bone graft obtained from reamings at the operative site is included; you only step up to 26862 when autograft is harvested from a separate anatomical location.

The 90-day global period covers all routine post-op care through day 90, including hardware checks and standard wound management. Each digit requires its own finger-level modifier (FA, F1–F9) per NCCI policy. When the same arthrodesis is performed on multiple fingers in one session, bill 26860 for the first joint, append the appropriate digit modifier, then use add-on code 26861 for each additional IP joint — whether that additional joint is on the same finger or a different finger.

Hand Surgery, Orthopedic Surgery, and Plastic and Reconstructive Surgery are the top billing specialties. Common settings are ASC and outpatient hospital; site-of-service differences are material, so verify your facility's contracted rates.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	4.76
Practice expense RVU	12.49
Malpractice RVU	0.91
Total RVU	18.16
Medicare national rate	$606.56
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	$606.56
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 26860 get rejected.

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

Missing or incorrect digit modifier (FA, F1–F9) — NCCI requires finger-level modifiers; absence triggers automatic bundling or rejection.
26860 billed multiple units without add-on code 26861 for additional joints, causing MUE-based denial on the primary code.
26862 billed when graft was obtained locally (reamings or allograft only); payers downcode to 26860 without documentation of a separate harvest site.
Global period conflict — evaluation or injection billed for a related complaint within the 90-day global without modifier 24 or 25.
Laterality not established — LT/RT omitted or contradicting the digit modifier, causing claim-level edit failure.

Frequently asked questions

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

01Do I use 26860 once per operative session or once per finger?

26860 is the primary code for the first IP joint fused. For each additional IP joint fused in the same session — on the same finger or a different finger — append add-on code 26861. Pair each unit with the corresponding digit modifier (FA, F1–F9).

02When does local bone graft or allograft cross over from 26860 to 26862?

Use 26860 when graft material comes from local reamings at the operative site or from allograft. Step up to 26862 only when autograft is harvested from a separate anatomical location — that separate harvest work is what 26862 is valued for.

03Can I bill hardware removal (26320) separately if I remove a K-wire at a follow-up visit during the 90-day global?

Routine hardware removal during the global period is bundled into 26860's global package. Separate billing for 26320 at the same site during the 90-day global will be denied unless you can document a distinct, unrelated indication — which is rarely supportable for planned K-wire removal after DIP fusion.

04Which digit modifiers are required, and does NCCI enforce them?

NCCI Chapter 4 explicitly requires FA (left thumb) or F1–F9 for finger procedures. MUE values for many finger codes are set to 1 per line based on this requirement, so multiple units without distinct digit modifiers will hit MUE edits. Bill one line per digit.

05If I perform 26860 on the same day as an unrelated hand procedure, do I need a modifier?

Yes. Append modifier 59 or XS to the secondary procedure to distinguish separate anatomical sites or distinct procedural services. If the procedures share an NCCI edit pair, confirm a modifier is allowed before appending — not all edits are modifier-bypassable.

06What is the correct approach for billing 26860 when the same finger has both DIP and PIP joints fused in one session?

Bill 26860 with the appropriate digit modifier for the primary joint, then 26861 with the same digit modifier for the additional joint on that same finger. 26861's descriptor — 'each additional interphalangeal joint' — explicitly covers additional joints on the same digit, not just additional digits.

Sources & references

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

Mira AI Scribe

The Mira AI Scribe captures the specific joint level (DIP vs. PIP), digit identification, fixation method, and graft source directly from dictation for CPT 26860. It flags when operative language defaults to 'standard approach' or omits graft source detail — the two documentation gaps most likely to trigger a 26860-to-26862 downcoding audit or a multi-digit modifier denial.

See how Mira captures CPT 26860 documentation