Summary & Overview
CPT 26262: Radical Resection of Distal Phalanx Finger Tumor
CPT code 26262 represents a radical surgical resection of a tumor located in the distal phalanx of a finger, including excision of adjacent healthy tissue when indicated for rapidly growing, recurrent, aggressive, or metastatic lesions. This code matters nationally because tumor resections of the hand carry clinical complexity, potential functional impact, and variable payer coverage considerations that affect access to specialty surgical care and downstream rehabilitation needs. Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, typical sites of service, and the service type for CPT code 26262. The publication also summarizes common payer approaches and benchmarks where available, highlights policy and coverage considerations relevant to surgical oncology in the hand, and outlines coding and billing elements that affect claims processing. Clinical context covers indications for radical resection versus more conservative excision and the implications for postoperative care and functional outcomes. Policy context addresses national payer coverage patterns and prior authorization trends that can influence care timelines. Data not available in the input is noted where payer-specific rates, associated taxonomies, and ICD-10 mappings would normally appear.
Billing Code Overview
CPT code 26262 describes a radical resection of a tumor of the distal phalanx of the finger, performed when a benign or malignant lesion is rapidly growing, recurrent, aggressive, or metastatic. The procedure involves excision of the tumor along with surrounding healthy tissue to achieve clear margins and reduce recurrence risk.
Service Type: Surgical — Tumor Resection / Oncology Surgery
Typical Site of Service: Ambulatory surgical center or hospital operating room, often within hand surgery, orthopedic surgery, or plastic/reconstructive surgery settings.
Clinical & Coding Specifications
Clinical Context
A 52-year-old patient presents to a hand surgery clinic with a rapidly enlarging, painful mass at the distal phalanx of the right index finger. Clinical history includes prior excision six months earlier with local recurrence and progressive limitation of fingertip motion. On examination there is a firm subcutaneous mass adherent to the nail bed and distal phalanx, with suspected cortical involvement on plain radiograph. MRI demonstrates a locally aggressive lesion suspicious for recurrent giant cell tumor of tendon sheath or superficial soft-tissue sarcoma involving the distal phalanx. The clinical workflow includes preoperative surgical planning with imaging review and informed consent, perioperative localization and excision under regional or general anesthesia, radical resection of the distal phalanx including surrounding soft tissue and involved nail bed, intraoperative margin assessment as indicated, specimen submission to pathology, and postoperative wound care with hand therapy referral as needed. Hospital outpatient or ambulatory surgery center scheduling is typical when inpatient admission is not required; immediate reconstruction or staged grafting may follow depending on defect size and margins.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
51 | Multiple procedures | When additional unrelated procedures are billed on the same day with this code as secondary to the primary procedure |