CPT code 26518: Knuckle fusion, multiple joints2026 Medicare rate & RVUs in Texas
Surgical fusion of multiple finger knuckle joints, reported when the operative plan permanently joins the joints rather than releasing or reconstructing them.
CMS doesn’t publish an office rate for 26518 in Texas.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
What 26518 covers
A hand surgeon prepares the involved finger knuckle joints and holds the joint surfaces together so they can fuse in a planned position. The operation may address painful deformity, instability, or joint damage when preserving motion is not the goal. It is generally performed in an operating room, with the operative report identifying each joint treated and the fixation or other techniques used.
Report this code for the multiple-joint fusion service it represents, using the operative documentation to support the joints fused and the work performed. It has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. For bilateral surgery, modifier 50 is paid at 150%. An assistant at surgery may be paid; co-surgeons require supporting documentation, and team surgery is not permitted.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 26518 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin, TX | Unavailable | $876.72 |
| Beaumont, TX | Unavailable | $806.50 |
| Brazoria, TX | Unavailable | $838.97 |
| Dallas, TX | Unavailable | $846.72 |
| Fort Worth, TX | Unavailable | $842.66 |
| Galveston, TX | Unavailable | $843.03 |
| Houston, TX | Unavailable | $878.17 |
| Rest of Texas | Unavailable | $823.90 |
How the 26518 rate is calculated
Each of 26518’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 26518
RVUs × geographic indexes × conversion factor
Work9.04
9.04 RVUs× 1.000 GPCI
Practice expense14.64
14.64 RVUs× 1.000 GPCI
Malpractice1.92
1.92 RVUs× 1.000 GPCI
Adjusted RVUs
25.6000
Conversion factor
$33.4009
Medicare rate
$855.06
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 26518
26518 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 26518
Knuckle fusion, multiple joints
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.69/0.21 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 26518
Knuckle fusion, multiple joints
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
26518 without 50 · national facility
$855.06
Knuckle fusion, multiple joints
26518-50 · Bilateral: 150%
$1,282.59
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
26518 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 26516Knuckle fusionMetacarpophalangeal joint
- Both describe knuckle-joint fusion services. Use the code whose CPT descriptor matches the specific joints and extent documented in the operative report.
- 26520Knuckle releaseMetacarpophalangeal joint
- This code addresses fusion; 26520 releases a knuckle-joint contracture without making fusion the operative goal.
- 26530Knuckle arthroplastyMetacarpophalangeal joint, no implant
- Fusion permanently joins the joint, while 26530 describes knuckle-joint revision intended to address the joint without the same fusion service.
26518 billing questions
How is this different from 26516?
Both codes concern fusion of knuckle joints, but the code choice depends on the specific service represented by the operative report. Confirm the joint sites and extent of fusion against the applicable CPT descriptor rather than choosing by the general term “knuckle.”
Is routine postoperative care separately reported?
The 90-day global period includes related postoperative care and the preoperative visit on the day before surgery. Separately report only services that are distinct from the included global care and meet applicable coding requirements.
How are multiple procedures in the same session paid?
The highest-valued procedure is paid in full; other procedures in the same session are subject to the standard multiple procedure reduction, with payment at 50%.
Can modifier 50 be used when both hands are treated?
CMS identifies this as a bilateral procedure. When performed bilaterally and reported with modifier 50, payment is at 150%.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeons are paid only with supporting documentation; team surgery is not permitted.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
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