Summary & Overview
CPT 26565: Metacarpal Bone Excision for Rotational Deformity
CPT code 26565 represents a metacarpal bone excision procedure performed to correct rotational deformities or abnormal bone growth in the hand. Nationally, this code captures a targeted orthopedic intervention that affects functional outcomes and postoperative resource use for patients with symptomatic metacarpal pathology. The procedure is relevant to surgical quality measurement, specialty reimbursement policies, and utilization management for hand and upper-extremity care.
Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, where it is typically performed, and the service type. The publication also summarizes common billing modifiers and payer coverage considerations, provides benchmarking context for utilization and reimbursement, and highlights policy and coding nuances that influence claims adjudication. This material is intended to inform billing staff, surgical practices, and policy analysts about coding expectations and the clinical rationale for the service, without offering clinical recommendations.
Billing Code Overview
CPT code 26565 describes a surgical procedure in which the provider excises part of a metacarpal bone to correct structural problems such as a rotational deformity or abnormal bone growth. This procedure is an orthopedic hand surgery aimed at restoring alignment, function, and comfort to the affected digit.
-
Service type: Surgical bone excision (orthopedic/hand surgery)
-
Typical site of service: Hospital outpatient department or ambulatory surgery center; may also be performed in an inpatient setting when clinically indicated.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 45-year-old right-hand–dominant patient presents with progressive rotational deformity and pain of the index metacarpal following a prior malunited metacarpal fracture. Conservative care including splinting, NSAIDs, and occupational therapy failed to restore alignment and function. Examination shows malrotation of the finger with difficulty performing fine pinch and grasp. Radiographs confirm abnormal metacarpal bone growth and rotational malalignment without active infection.
The patient is scheduled for surgical correction under regional block or general anesthesia in an ambulatory surgery center or hospital outpatient department. The surgeon performs an osteotomy with excision of a segment of the metacarpal to correct rotation and realigns the bone, with internal fixation as indicated. Preoperative evaluation, informed consent, perioperative antibiotics, intraoperative imaging, and postoperative hand therapy are part of the clinical workflow. Typical sites of service include an ambulatory surgery center, hospital outpatient surgery, or inpatient operating room if medically indicated. Service type: surgical, orthopedic/hand surgery procedure (metacarpal bone excision/osteotomy).
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing only the surgeon's professional service separate from a technical component (rare for surgery without separate technical component). |