Summary & Overview
CPT 26605: Closed Reduction of Metacarpal Fracture with Manipulation
CPT code 26605 denotes a closed reduction with manipulation of metacarpal bone fractures. This procedure is a common, often time-sensitive intervention to prevent deformity, alleviate pain, and restore hand function after acute hand injuries. Nationally, proper use and coding of 26605 affect access to timely orthopedic and hand surgery care and influence billing consistency across emergency departments, ambulatory surgical centers, and outpatient surgical suites.
Key payers addressed in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical indications for closed metacarpal reduction, typical sites of service, common billing practices, and payer-specific coverage trends where available. The publication summarizes benchmarks for utilization, documents relevant coding considerations, and highlights policy updates that impact claim submission and payment for closed fracture management.
The report is intended for clinicians, coding professionals, and policy analysts seeking a concise reference on CPT code 26605, its clinical context, and implications for national payer policy and reimbursement practices. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 26605 describes a closed reduction of each metacarpal bone fracture with manipulation. The procedure is performed to prevent deformity, relieve pain, and restore hand function following metacarpal fractures.
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Service type: Fracture management / closed reduction with manipulation
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Typical site of service: Outpatient surgical suite, emergency department, or ambulatory surgery center where closed fracture reductions are commonly performed
Clinical & Coding Specifications
Clinical Context
A 28-year-old right-hand–dominant construction worker presents to the emergency department after a fall from a ladder with direct trauma to the right hand. He reports acute pain, swelling, and deformity over the metacarpal region of the hand with limited range of motion. Radiographs reveal a displaced transverse fracture of the fifth metacarpal shaft without open wound or neurovascular compromise. The orthopedic hand surgeon performs a closed reduction with manipulation under local regional anesthesia and conscious sedation in the procedure room to restore alignment, prevent rotational deformity, relieve pain, and preserve hand function. Post-reduction radiographs confirm acceptable alignment, and the hand is immobilized with a short-arm plaster splint. The patient is given hand therapy follow-up instructions and scheduled for repeat radiographs and clinic visit within 7–10 days to monitor healing and range of motion recovery.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Provider’s default or usual procedural service | Use when the service is the usual, routine procedure performed by the reporting provider. |
22 | Increased procedural services | Use when work required is substantially greater than typical for , documented with rationale (e.g., difficult reduction, multiple attempts). |