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CPT 26650: Percutaneous Pinning for Displaced Thumb-Base Fracture

CPT code 26650 represents percutaneous manipulation and pinning of a displaced intra-articular fracture at the base of the thumb near the wrist. This procedure restores joint alignment and stabilizes bone fragments by inserting wires or pins through the skin into bone. It is a common orthopedic intervention for distal radial/first carpometacarpal region fractures that involve the articular surface and require fixation to optimize healing and preserve function. Nationally, accurate coding of this procedure affects surgical quality reporting, facility and professional billing, and case-level resource allocation. Key payers for this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, typical sites of service, and an overview of billing considerations tied to the code. The publication also outlines common modifiers used with this service and indicates where additional diagnostic coding and related code mappings would apply. Data not available in the input is noted where applicable.

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Billing Code Overview

CPT code 26650 describes manipulation of a displaced intra-articular fracture at the base of the thumb near the wrist with percutaneous insertion of wires or pins to restore alignment and stabilize the fracture for healing. The procedure involves realigning fractured articular surfaces and placing fixation devices through the skin into the bones to hold fragments in position.

Service type: Percutaneous closed manipulation with percutaneous pinning (orthopedic fracture fixation)
Typical site of service: Ambulatory surgical center or hospital operating room (procedures performed in a surgical setting under appropriate anesthesia)

Data not available in the input.

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CPT 26650: Percutaneous Pinning for Displaced Thumb-Base Fracture

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Billing Code Overview

Service type: Percutaneous closed manipulation with percutaneous pinning (orthopedic fracture fixation)
Typical site of service: Ambulatory surgical center or hospital operating room (procedures performed in a surgical setting under appropriate anesthesia)

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 42-year-old right-hand-dominant patient presents to the emergency department after a fall onto an outstretched hand. Evaluation demonstrates pain, swelling, and deformity at the base of the thumb. Radiographs show a displaced intra-articular fracture of the first carpometacarpal joint (thumb base) with joint surface incongruity. The orthopedic hand surgeon discusses options and determines closed or percutaneous manipulation with pin fixation is appropriate to restore alignment and stabilize the fracture. The procedure is performed in an operating room or procedure suite under regional or general anesthesia. The surgeon manipulates the fracture to anatomic alignment and inserts percutaneous Kirschner wires (K-wires) across the thumb metacarpal into the trapezium/scaphoid as needed to hold reduction. Post-procedure radiographs confirm position. The patient is placed in a thumb spica splint or cast and discharged with wound care, pin-site instructions, and follow-up within 1–2 weeks for pin assessment and radiographic monitoring until consolidation.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the physician’s professional portion if a separate technical component is billed by the facility.
`50`	Bilateral procedure	Use when the same percutaneous fixation procedure is performed on both thumbs during the same operative session.
`51`	Multiple procedures	Use when this procedure is performed in addition to other distinct procedures on the same claim; sequence rules apply.
`52`	Reduced services	Use when the procedure was partially reduced or not completed as originally planned.
`53`	Discontinued procedure	Use when the procedure was started but then terminated due to extenuating circumstances or patient safety.
`58`	(Not in provided list)	Data not available in the input.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons performing distinct portions of the procedure.
`78`	Return to OR for related procedure during postoperative period	Use when an unplanned return to the operating room for treatment related to the original procedure occurs.
`79`	Unrelated procedure or service by the same physician during the postoperative period	Use when a separate unrelated surgical procedure is performed during global period.
`LT`	Left side	Use to indicate the left thumb was treated.
`RT`	Right side	Use to indicate the right thumb was treated.
`TC`	Technical component	Use when billing only the facility/technical component of the service (e.g., OR and supplies).
`59`	Distinct procedural service	Use to indicate a separate and distinct service/procedure was performed on the same day (careful documentation required).
`76`	(Not in provided list)	Data not available in the input.

Taxonomy Code	Specialty	Notes
2080P0200X	Orthopedic Surgery	Hand and upper extremity surgeons commonly perform percutaneous fixation of thumb base fractures.
207X00000X	Otolaryngology (Not typical)	Data not available in the input.
207L00000X	Plastic and Reconstructive Surgery	Plastic surgeons with hand specialization perform operative fixation and reconstruction of hand fractures.
207RH0000X	Hand Surgery (subspecialty via orthopedics)	Surgeons with hand certification commonly manage complex thumb base injuries.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S62.104A`	Displaced fracture of base of first metacarpal bone, right hand, initial encounter for closed fracture	Common indication for closed reduction and percutaneous pinning of thumb base fractures.
`S62.105A`	Displaced fracture of base of first metacarpal bone, left hand, initial encounter for closed fracture	Indicates left thumb base displacement requiring manipulation and fixation.
`S62.101A`	Fracture of first metacarpal bone, unspecified, initial encounter for closed fracture	Used when laterality or precise displacement is not specified but treatment is similar.
`S62.106A`	Displaced fracture of base of first metacarpal bone, unspecified, initial encounter	Alternative code reflecting unspecified laterality with clinical relevance to fixation.
`S62.00XA`	Fracture of metacarpal bone(s), unspecified, initial encounter for closed fracture	May be used when multiple metacarpals are involved including the first and require fixation.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`25605`	Closed treatment of distal radial fracture (e.g., manipulation) without manipulation requiring anesthesia; age >20 years	May be performed in patients with concurrent distal radius fractures requiring closed reduction in the same encounter.
`25445`	Closed treatment of metacarpal fracture, includes manipulation, without internal fixation	May be used when adjacent metacarpal fractures are treated by closed manipulation rather than percutaneous pinning.
`20670`	Removal of implanted pins, each	Used for removal of percutaneous `K-wires` once the thumb-base fracture has healed.
`20680`	Removal of implant deep (e.g., buried pins)	Used when pins are buried and require a deeper removal procedure in the operating room.
`25120`	Injection, tendon sheath or ligament, therapeutic	May be used for postoperative management of pain or stiffness in adjacent joints (rarely performed at the same session).

CPT 26600: Nonoperative Management of Metacarpal Fracture

CPT-26605-CLOSED-REDUCTION-METACARPAL-FRACTURE-MANIPULATION

CPT 26605: Closed Reduction of Metacarpal Fracture with Manipulation

CPT-26607-METACARPAL-FRACTURE-CLOSED-REDUCTION-EXTERNAL-FIXATION

CPT 26607: Closed Reduction of Metacarpal Fracture with External Fixation

CPT-26608-PERCUTANEOUS-FIXATION-METACARPAL-FRACTURE

CPT 26608: Percutaneous Fixation of Metacarpal Fracture

CPT-26615-METACARPAL-FRACTURE-REPAIR-OPEN-FIXATION-HAND

CPT 26615: Open Repair of Metacarpal Fracture with Internal Fixation

CPT-26641-THUMB-JOINT-CLOSED-MANIPULATION

CPT 26641: Closed Manipulation of Thumb Base Joint Dislocation

CPT-26645-CLOSED-MANIPULATION-THUMB-BASE-FRACTURE

CPT 26645: Closed Manipulation of Thumb-Base Fracture

CPT-26665-THUMB-METACARPAL-BASE-FRACTURE-CMC-DISLOCATION-OPEN-REPAIR

CPT 26665: Open Repair of Thumb Metacarpal Base Fracture with CMC Dislocation

CPT-26670-CLOSED-MANIPULATION-HAND-WRIST-JOINT-REDUCTION

CPT 26670: Closed Manipulation of Displaced Hand/Wrist Joint

CPT-26675-CLOSED-REDUCTION-WRIST-HAND-JOINT

CPT 26675: Closed Reduction of Displaced Wrist-Hand Joint

Showing 1–10 of 32

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the physician’s professional portion if a separate technical component is billed by the facility.
`50`	Bilateral procedure	Use when the same percutaneous fixation procedure is performed on both thumbs during the same operative session.
`51`	Multiple procedures	Use when this procedure is performed in addition to other distinct procedures on the same claim; sequence rules apply.
`52`	Reduced services	Use when the procedure was partially reduced or not completed as originally planned.
`53`	Discontinued procedure	Use when the procedure was started but then terminated due to extenuating circumstances or patient safety.
`58`	(Not in provided list)	Data not available in the input.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons performing distinct portions of the procedure.
`78`	Return to OR for related procedure during postoperative period	Use when an unplanned return to the operating room for treatment related to the original procedure occurs.
`79`	Unrelated procedure or service by the same physician during the postoperative period	Use when a separate unrelated surgical procedure is performed during global period.
`LT`	Left side	Use to indicate the left thumb was treated.
`RT`	Right side	Use to indicate the right thumb was treated.
`TC`	Technical component	Use when billing only the facility/technical component of the service (e.g., OR and supplies).
`59`	Distinct procedural service	Use to indicate a separate and distinct service/procedure was performed on the same day (careful documentation required).
`76`	(Not in provided list)	Data not available in the input.

Taxonomy Code	Specialty	Notes
2080P0200X	Orthopedic Surgery	Hand and upper extremity surgeons commonly perform percutaneous fixation of thumb base fractures.
207X00000X	Otolaryngology (Not typical)	Data not available in the input.
207L00000X	Plastic and Reconstructive Surgery	Plastic surgeons with hand specialization perform operative fixation and reconstruction of hand fractures.
207RH0000X	Hand Surgery (subspecialty via orthopedics)	Surgeons with hand certification commonly manage complex thumb base injuries.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S62.104A`	Displaced fracture of base of first metacarpal bone, right hand, initial encounter for closed fracture	Common indication for closed reduction and percutaneous pinning of thumb base fractures.
`S62.105A`	Displaced fracture of base of first metacarpal bone, left hand, initial encounter for closed fracture	Indicates left thumb base displacement requiring manipulation and fixation.
`S62.101A`	Fracture of first metacarpal bone, unspecified, initial encounter for closed fracture	Used when laterality or precise displacement is not specified but treatment is similar.
`S62.106A`	Displaced fracture of base of first metacarpal bone, unspecified, initial encounter	Alternative code reflecting unspecified laterality with clinical relevance to fixation.
`S62.00XA`	Fracture of metacarpal bone(s), unspecified, initial encounter for closed fracture	May be used when multiple metacarpals are involved including the first and require fixation.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`25605`	Closed treatment of distal radial fracture (e.g., manipulation) without manipulation requiring anesthesia; age >20 years	May be performed in patients with concurrent distal radius fractures requiring closed reduction in the same encounter.
`25445`	Closed treatment of metacarpal fracture, includes manipulation, without internal fixation	May be used when adjacent metacarpal fractures are treated by closed manipulation rather than percutaneous pinning.
`20670`	Removal of implanted pins, each	Used for removal of percutaneous `K-wires` once the thumb-base fracture has healed.
`20680`	Removal of implant deep (e.g., buried pins)	Used when pins are buried and require a deeper removal procedure in the operating room.
`25120`	Injection, tendon sheath or ligament, therapeutic	May be used for postoperative management of pain or stiffness in adjacent joints (rarely performed at the same session).

CPT 26600: Nonoperative Management of Metacarpal Fracture

CPT-26605-CLOSED-REDUCTION-METACARPAL-FRACTURE-MANIPULATION

CPT 26605: Closed Reduction of Metacarpal Fracture with Manipulation

CPT-26607-METACARPAL-FRACTURE-CLOSED-REDUCTION-EXTERNAL-FIXATION

CPT 26607: Closed Reduction of Metacarpal Fracture with External Fixation

CPT-26608-PERCUTANEOUS-FIXATION-METACARPAL-FRACTURE

CPT 26608: Percutaneous Fixation of Metacarpal Fracture

CPT-26615-METACARPAL-FRACTURE-REPAIR-OPEN-FIXATION-HAND

CPT 26615: Open Repair of Metacarpal Fracture with Internal Fixation

CPT-26641-THUMB-JOINT-CLOSED-MANIPULATION

CPT 26641: Closed Manipulation of Thumb Base Joint Dislocation

CPT-26645-CLOSED-MANIPULATION-THUMB-BASE-FRACTURE

CPT 26645: Closed Manipulation of Thumb-Base Fracture

CPT-26665-THUMB-METACARPAL-BASE-FRACTURE-CMC-DISLOCATION-OPEN-REPAIR

CPT 26665: Open Repair of Thumb Metacarpal Base Fracture with CMC Dislocation

CPT-26670-CLOSED-MANIPULATION-HAND-WRIST-JOINT-REDUCTION

CPT 26670: Closed Manipulation of Displaced Hand/Wrist Joint

CPT-26675-CLOSED-REDUCTION-WRIST-HAND-JOINT

CPT 26675: Closed Reduction of Displaced Wrist-Hand Joint

Showing 1–10 of 32

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

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CPT 26650: Percutaneous Pinning for Displaced Thumb-Base Fracture

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Billing Code Overview

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CPT 26650: Percutaneous Pinning for Displaced Thumb-Base Fracture

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

CPT 26650: Percutaneous Pinning for Displaced Thumb-Base Fracture

Sign up for cpt 26650 policy alerts

Billing Code Overview

CPT 26650: Percutaneous Pinning for Displaced Thumb-Base Fracture

Sign up for cpt 26650 policy alerts

Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What procedure and clinical scenario does CPT 26650 cover?

Which modifiers are commonly used with CPT 26650 and when should they be applied?

Are there related CPT codes I should be aware of when billing for CPT 26650?

What diagnosis codes commonly support medical necessity for CPT 26650?

Which specialties, sites of service, and payers are associated with CPT 26650?

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What procedure and clinical scenario does CPT 26650 cover?

Which modifiers are commonly used with CPT 26650 and when should they be applied?

Are there related CPT codes I should be aware of when billing for CPT 26650?

What diagnosis codes commonly support medical necessity for CPT 26650?

Which specialties, sites of service, and payers are associated with CPT 26650?

References