Summary & Overview
CPT 26116: Excision of Subfascial Hand or Finger Lesion, <1.5 cm
CPT code 26116 identifies the surgical excision of a subfascial tumor or vascular malformation from the soft tissue of the hand or finger when the resection is under 1.5 cm. This narrowly defined procedural code captures a common minor hand surgical intervention performed to remove symptomatic or potentially problematic soft-tissue lesions and has implications for surgical coding, preauthorization, and site-of-service determinations nationwide. Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical context of the procedure, typical sites of service, and the billing parameters tied to size-based reporting. The publication summarizes benchmark payment ranges, common modifiers used with the code, and payer-specific coverage considerations where available. It also outlines related service lines and codes commonly billed alongside 26116, as well as practical notes on documentation elements that support medical necessity for removal of subfascial hand lesions. Data not available in the input for taxonomies, specific ICD-10 diagnosis pairings, and payer-specific fee schedules are noted where applicable.
Billing Code Overview
CPT code 26116 describes the excision of a subfascial tumor or vascular malformation from the soft tissue of the hand or finger when the resection size is under 1.5 cm. The service involves surgical removal of a localized lesion located beneath the fascial plane within the soft tissues of the hand or digits.
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Service type: Surgical excision of soft tissue lesion (hand/finger)
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Typical site of service: Ambulatory surgical center or hospital outpatient department; may also occur in an office-based procedure setting depending on facility capabilities and clinical factors
Clinical & Coding Specifications
Clinical Context
A 45-year-old patient presents to the outpatient hand clinic with a slowly enlarging, palpable mass on the volar aspect of the index finger that has begun to cause pain and restriction of motion. Physical exam demonstrates a firm, mobile subfascial nodule approximately 1 cm in greatest dimension without overlying skin changes. Ultrasound confirms a small vascular malformation or soft tissue tumor confined to the subfascial plane of the finger. The patient is scheduled for operative excision under regional block or local anesthesia with monitored anesthesia care. The clinical workflow includes preoperative evaluation and consent, surgical site marking, operative excision of the lesion measuring less than 1.5 cm, intraoperative hemostasis, possible specimen submission to pathology, dressing application, postoperative recovery and discharge with wound care and follow-up. Typical site of service is an ambulatory surgery center or hospital outpatient department; procedure is performed by a hand surgeon or orthopedic/plastic surgeon with hand expertise. Billing uses 26116 for excision of a subfascial tumor or vascular malformation of the hand or finger with resection size under 1.5 cm. Common payer interactions include authorization where required by Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare for facility and professional components as applicable.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT | Left side | Use when the lesion is on the left hand or finger. |
RT | Right side | Use when the lesion is on the right hand or finger. |
26 | Professional component | Use when reporting only the surgeon's professional service separate from facility charges. |
TC | Technical component | Use when billing only the facility/technical component; rarely used for surgical codes but applicable to global splits. |
50 | Bilateral procedure | Use when identical procedures are performed on both hands or corresponding fingers (verify payer bilateral rules). |
22 | Increased procedural services | Use when work required is substantially greater than typical for 26116 with documentation of reason. |
52 | Reduced services | Use when the procedure is partially reduced or not completed as documented. |
53 | Discontinued procedure | Use when procedure is started but discontinued due to extenuating circumstances. |
59 | Distinct procedural service | Use when another distinct procedure is performed on the same day that is not normally bundled. |
76 | Repeat procedure by same physician | Use when the same procedure is repeated by the same physician within the global period (not in provided list — Data not available in the input.) |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207L00000X | Orthopaedic Surgery | Orthopedic hand surgeons commonly perform this excision. |
208U00000X | Plastic Surgery | Plastic surgeons with hand specialization perform soft tissue tumor excisions. |
207P00000X | Hand Surgery | Certified hand surgeons (often dual-trained) commonly perform this procedure. |
207T00000X | General Surgery | Some general surgeons with hand experience may perform hand tumor excisions. |
208000000X | Dermatology | Dermatologic surgeons may perform small superficial soft tissue excisions of the finger when appropriate. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
M67.4 | Ganglion, unspecified | Common benign soft tissue mass of the wrist/hand that may require excision when symptomatic. |
D18.0 | Hemangioma of skin and subcutaneous tissue | Vascular malformations in the hand may be coded here when excised. |
M89.8 | Other specified disorders of bone, not elsewhere classified | Used when tumor extends to bone or causes bony involvement needing excision. |
M79.6 | Pain in limb | Symptom code sometimes reported in addition to definitive diagnosis when pain is a primary complaint. |
D48.6 | Neoplasm of uncertain behavior of other and unspecified sites | Used for lesions with uncertain behavior pending pathology. |
C44.599 | Malignant neoplasm of skin of unspecified part of unspecified finger, unspecified | Malignant skin tumors of the finger that may require excision and further oncologic management. |
L98.9 | Disorder of skin and subcutaneous tissue, unspecified | General code for non-specific soft tissue lesions when more specific code unavailable. |
M67.8 | Other specified disorders of synovium and tendon | Relevant when lesion arises from tendon sheath (e.g., giant cell tumor of tendon sheath). |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
26010 | Excision of tumor, soft tissue of finger or toe; subcutaneous, single lesion | Used for superficial subcutaneous lesions of the finger; may be reported instead of 26116 when lesion is subcutaneous rather than subfascial. |
26160 | Closed treatment of metacarpal fracture, each | Not directly related to tumor excision but commonly performed in the hand surgery practice; included for context when combined hand injuries exist. |
25220 | Excision of tumor or mass of wrist tendons, tendon sheath, or ganglion, open; single lesion | Used for wrist/hand soft tissue tumor excision when anatomic location is proximal to the finger/hand area coded by 26116. |
20550 | Injection(s); single tendon sheath, or ligament, aponeurosis (e.g., trigger finger) | May be performed in the same clinic setting for related tendon pathology; distinct from excision but could be billed separately if appropriate. |
20220 | Excision of lesion of bone; metacarpal or phalangeal | Used when the lesion involves underlying bone and requires bony excision rather than soft tissue resection. |
Note: If any related CPT codes were provided in the input, they would be listed above. If none were supplied, standard related hand surgery codes are included.