Add-on code for arthrodesis of each additional interphalangeal joint fused with autograft at the same operative session as the primary procedure.

Verified May 8, 2026 · 5 sources ↓

Medicare: $191.72
Work RVU: 3.79
Global, days
Region: Hand

Drawn from CMSAAPCJnjmedtechMcweb

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Identify each additional interphalangeal joint fused by name and finger (e.g., ring finger DIP, small finger PIP) — vague references to 'additional joints' trigger audits.
Document autograft harvest site, technique, and that graft harvest is included in this code — do not bill a separate graft-harvest CPT.
Operative note must establish that 26862 was performed at the same session as the basis for reporting 26863 as an add-on.
Specify fixation method used (K-wire, headless compression screw, plate) for each joint fused.
Document pre-operative diagnosis supporting fusion at each additional joint (e.g., post-traumatic arthritis, deformity, failed conservative treatment).
Record patient positioning, tourniquet use, and approach for each joint to support medical necessity and time if modifier 22 is considered.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 59 Distinct service LT Left side RT Right side 80 Assistant surgeon AS PA/NP/CNS assistant

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 26863 is an add-on code (ZZZ global period) reported for each additional interphalangeal joint of the hand that undergoes arthrodesis with autograft during the same session as the primary interphalangeal joint fusion. It pairs exclusively with 26862 — never reported alone. The autograft harvest is included; do not separately bill a graft-harvesting code.

The ZZZ global period means 26863 inherits the global period of its primary code (26862). Post-op management, wound checks, and hardware monitoring all fall under that parent code's global. If additional, unrelated procedures or E/M services are billed on the same date, standard modifier rules for the primary code apply.

For facility billing, 26863 carries a payment indicator of N (packaged) in both HOPD and ASC settings, meaning no separate facility payment is issued — reimbursement rolls into the primary procedure's APC. Physician work is still captured via the professional fee.

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 (3.79) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (5.74) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	3.79
Practice expense RVU	1.25
Malpractice RVU	0.7
Total RVU	5.74
Medicare national rate	$191.72
Global period	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	$191.72

Common denial reasons

The recurring reasons claims for CPT 26863 get rejected.

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

Billed without the required primary code 26862 on the same claim — 26863 is an add-on and cannot stand alone.
Payer bundles 26863 into 26862 when operative note does not clearly distinguish each additional joint fused with autograft.
Separate billing for autograft harvest on top of 26863 — harvest is included and will be denied as unbundling.
Facility claim denied because 26863 has a packaged (N) payment indicator in HOPD and ASC settings — no separate facility payment is issued.
Insufficient documentation of medical necessity for fusing multiple joints in a single session, leading to downcoding or denial of the additional joint.

Frequently asked questions

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

01Can 26863 be billed without 26862 on the same claim?

No. 26863 is strictly an add-on code and requires 26862 as the primary procedure on the same date of service. Submitting 26863 alone will result in an automatic denial.

02How many units of 26863 can be reported in one session?

One unit per each additional interphalangeal joint fused with autograft beyond the primary joint. If you fuse three joints total with autograft, bill 26862 once and 26863 twice — each additional joint gets its own unit, documented individually in the operative note.

03Is autograft harvest billed separately when reporting 26863?

No. Autograft harvest is included in 26863 by definition. Billing a separate graft-harvest code alongside 26863 is unbundling and will be denied or recouped on audit.

04What is the global period for 26863 and how does it affect post-op billing?

26863 carries a ZZZ global period, meaning it inherits the global period of its parent code, 26862. All routine post-op care falls under the primary code's global. Bill unrelated services with modifier 79 if needed during that window.

05Does 26863 get separate facility reimbursement in the ASC or HOPD setting?

No. In both ASC and HOPD settings, 26863 has a packaged payment indicator (N), meaning the facility payment is bundled into the primary procedure's APC. Physician professional fee billing is unaffected.

06When is modifier 22 appropriate with 26863?

If the work for the additional joint fusion was substantially greater than typical — for example, due to severe deformity, prior failed arthrodesis, or significantly increased operative time — modifier 22 can be appended to the primary code (26862) with supporting documentation. Apply it to the primary, not the add-on.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the specific finger, joint level (DIP vs. PIP), autograft harvest site, and fixation hardware for each additional joint fused during dictation. It flags the operative note when the primary procedure (26862) is not explicitly documented in the same session, preventing the most common reason 26863 gets denied outright — submission without a valid primary code.

See how Mira captures CPT 26863 documentation