Ray amputation of a single metacarpal bone with its associated finger or thumb, with or without interosseous muscle transfer to optimize remaining hand function.

Verified May 8, 2026 · 8 sources ↓

Medicare: $740.50
Work RVU: 7.6
Global, days: 90
Region: Hand

Drawn from CMSAAPCMdclarityNIHAoassn

Documentation requirements

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

Source · Editorial brief grounded in 8 cited references ↓

Specify which ray (thumb, index, long, ring, small) and which hand was amputated
Document the clinical indication: trauma, malignancy, infection, gangrene, or other pathology requiring ray-level resection
State explicitly whether interosseous muscle transfer was performed or omitted — the code covers both, but the note must reflect what was done
Describe the surgical approach: incision design, extent of metacarpal resection, and method of soft-tissue closure
If multiple rays were amputated in the same session, document each ray separately to support additional units billed with modifier 51
Record anesthesia type (general vs. regional block) and tourniquet use, standard for hand OR documentation

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 52 Reduced services 58 Staged or related 59 Distinct service 76 Repeat, same physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 8 cited references ↓

CPT 26910 describes a ray amputation — removal of a finger or thumb together with its corresponding metacarpal bone — performed as a single-ray procedure. Interosseous muscle transfer is included in the code when performed; it is not separately billable. Indications include severe trauma, malignancy, advanced infection, gangrene, or frostbite where digit salvage is not viable and preserving hand architecture is the surgical goal.

26910 carries a 90-day global period. All routine post-op wound care, dressing changes, suture removal, and follow-up visits through day 90 are bundled. If you see the patient for an unrelated condition during that window, append modifier 24 to the E/M. A new problem that requires a separate, significant service on the same day as surgery takes modifier 25 on the E/M before the procedure.

When multiple rays require amputation in the same operative session, 26910 covers only one ray. Additional rays amputated simultaneously are reported with modifier 51 on the secondary unit. Laterality modifiers LT and RT are essential — payers expect them on every hand procedure. If the procedure is performed on both hands in the same session, modifier 50 applies with a single line.

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 (7.6) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (22.17) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	7.6
Practice expense RVU	13.08
Malpractice RVU	1.49
Total RVU	22.17
Medicare national rate	$740.50
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	$740.50
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 26910 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 triggers payer edit or auto-denial
Bundling conflict when interosseous transfer is billed separately; it is included in 26910 and not separately reimbursable
ICD-10 diagnosis mismatch — payers reject claims where the stated diagnosis (e.g., benign lesion) does not support ray-level amputation; use the most specific trauma, infection, or malignancy code
Multiple units billed without modifier 51 when more than one ray is amputated in the same session
Post-op E/M billed without modifier 24 during the 90-day global period, triggering automatic denial as a bundled service

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 8 cited references ↓

01Is interosseous transfer a separately billable add-on to 26910?

No. Interosseous muscle transfer is included in 26910 whether or not it is performed. You cannot unbundle it as a separate service.

02If I amputate two rays in the same operative session, how do I bill?

Report 26910 twice. List the higher-complexity ray first, then the second unit with modifier 51. Document each ray distinctly in the operative note.

03Which laterality modifier applies when the patient only has one hand?

Still append LT or RT corresponding to the hand operated on. Payer edits check for laterality regardless of the clinical context — omitting it delays payment.

04What modifier covers a return to the OR during the global period to revise the stump?

Modifier 78 — unplanned return for a procedure related to the original surgery. If the OR visit is for a completely unrelated problem, use modifier 79 instead. Don't invert these.

05Can I bill an E/M on the same day as 26910 for a separate medical decision?

Yes, but only if the E/M addresses a problem distinct from the amputation. Append modifier 25 to the E/M. Document the separate medical issue clearly; without it, payers bundle the visit into the surgical package.

06Does 26910 have a 90-day global, and what does that include?

Yes, 90-day global. It covers the day-before pre-op visit, the surgery day, and all routine post-op care through day 90 — wound checks, dressing changes, suture removal, and uncomplicated follow-up. Bill modifier 24 on any E/M for unrelated conditions during that period.

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 ray amputated (e.g., ring finger with its fourth metacarpal), laterality, interosseous transfer status, clinical indication, and extent of bone resection directly from operative dictation. This prevents the two most common audit flags for 26910: missing laterality on the claim and operative notes that don't explicitly address whether muscle transfer was performed.

See how Mira captures CPT 26910 documentation