Fusion · Hand

Arthrodesis of a finger interphalangeal joint with autograft harvesting included — permanently fusing the joint using bone graft taken from the patient's own body.

Verified May 8, 2026 · 5 sources ↓

Medicare: $737.49
Work RVU: 7.37
Global, days: 90
Region: Hand

Drawn from CMSAbosAAPC

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 interphalangeal joint(s) were fused — PIP vs. DIP and exact digit using FA/F1–F9 notation.
Document that autograft was harvested and identify the donor site (e.g., distal radius, iliac crest).
Confirm internal fixation method used (K-wire, headless screw, plate) or explicitly note fixation was not used.
Record the underlying indication — osteoarthritis, post-traumatic arthritis, rheumatoid arthritis, deformity — with supporting ICD-10 code.
Operative note must name the specific joint approach and confirm graft incorporation intent, not just 'standard approach'.
If billing 26863 for an additional joint, the note must describe the second (or further) fusion distinctly — separate joint, separate graft harvest documentation.

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 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

26862 covers interphalangeal (IP) joint arthrodesis of the finger with autograft, where graft harvest is bundled into the code — do not separately bill graft procurement codes such as 20900–20924. Internal fixation (K-wires, screws, plates) is included whether or not it's used. The distinction from 26860 is the autograft: if you fused the joint without harvesting the patient's own bone, 26860 is correct; if you harvested autograft, 26862 applies.

For each additional IP joint fused with autograft in the same operative session, add 26863 (not 26861 — 26861 is the add-on for 26860, the non-graft version). Stacking the wrong add-on is a frequent claim error. Finger-specific modifiers FA and F1–F9 are required to distinguish which digit was treated; the MUE for many finger procedures is one unit, so without digit modifiers, multi-finger claims will hit a brick wall.

The 90-day global period means all routine post-op management, hardware checks, and related dressing changes through day 90 are bundled. Separate billing in that window requires modifier 24 (E&M unrelated to the surgery) or 79 (unrelated procedure). A planned staged revision or hardware removal for the same joint uses modifier 58.

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 (7.37) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (22.08) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	7.37
Practice expense RVU	13.32
Malpractice RVU	1.39
Total RVU	22.08
Medicare national rate	$737.49
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	$737.49
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 26862 get rejected.

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

Billing 26861 instead of 26863 as the add-on when autograft was used — 26861 pairs with 26860, not 26862.
Missing digit-level modifier (FA, F1–F9) causes MUE edits to reject multi-finger claims.
Separate billing of bone graft harvest codes (20900–20924) when graft is already included in 26862 descriptor.
Claim submitted during the 90-day global of a prior finger procedure without modifier 79 or 58 as appropriate.
ICD-10 diagnosis does not support permanent arthrodesis — payers may reject if documentation reflects a reversible or non-arthritic condition without adequate clinical rationale.

Frequently asked questions

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

01What's the difference between 26860 and 26862?

26860 is IP joint arthrodesis without autograft. 26862 is the same fusion but includes harvest of the patient's own bone graft. If you didn't harvest autograft, 26860 is correct — billing 26862 without documented graft harvest is upcoding.

02Which add-on code do I use when fusing a second IP joint with autograft in the same session?

Use 26863, not 26861. 26861 is the add-on for 26860 (no autograft). 26863 is the add-on for 26862 when additional joints are fused with autograft. Mixing these up is a persistent claim error in multi-digit arthrodesis cases.

03Do I need finger-specific modifiers like F1–F9?

Yes. CMS NCCI policy explicitly requires FA and F1–F9 modifiers for finger procedures. The MUE for 26862 is set at one unit per digit, so if you fused two fingers, you need two lines with distinct digit modifiers or the second unit will deny.

04Can I separately bill for bone graft harvest when using 26862?

No. The 26862 descriptor includes obtaining the autograft. Separately reporting graft procurement codes such as 20900 or 20902 is incorrect per NCCI bundling principles — those codes will be denied or recouped on audit.

05How does the 90-day global period affect post-op billing?

All routine follow-up, wound care, and hardware-related visits through day 90 are bundled. If the patient presents for a completely unrelated problem during that window, bill the E&M with modifier 24. If a separate unrelated procedure is performed, use modifier 79. A planned staged procedure (e.g., hardware removal anticipated at time of fusion) uses modifier 58.

06Is modifier 51 appropriate when 26862 is performed with other hand procedures on the same day?

Modifier 51 applies to secondary procedures when multiple surgeries are billed on the same date of service. Whether it reduces payment depends on payer rules — Medicare applies a multiple procedure reduction, but some commercial payers do not. Confirm with individual payer contracts before assuming a reduction applies.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the interphalangeal joint level (PIP vs. DIP), the specific digit, autograft donor site, and fixation method from the surgeon's dictation — populating the operative note fields that drive both code selection (26862 vs. 26860) and digit modifier assignment (FA, F1–F9). This prevents the most common 26862 denial: a note that confirms fusion but fails to document graft harvest or digit identity, triggering a down-code to 26860 or an MUE rejection.

See how Mira captures CPT 26862 documentation