CPT code 26531: Knuckle arthroplasty, with implant2026 Medicare rate & RVUs in Puerto Rico
Reports implant arthroplasty of a metacarpophalangeal joint to address painful joint destruction or deformity while preserving finger motion.
In Puerto Rico, Medicare pays $590.45 for 26531 in a facility. There’s no office rate.
Check a contract rate as a % of Medicare · 26531 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
What 26531 covers
A hand surgeon removes damaged joint surfaces at a metacarpophalangeal (MCP) joint and places an implant to improve alignment and preserve motion. Typical cases include painful MCP destruction and deformity from rheumatoid arthritis, or joint damage from other causes. The procedure is generally performed in an operating room, with the specific finger and joint identified in the operative report.
Report this code when the operation includes an implant at the MCP joint; distinguish it from MCP arthroplasty without an implant and implant arthroplasty at a finger interphalangeal joint. Documentation should establish the treated joint, the underlying problem, and implant placement. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment may be available; co-surgeon payment requires 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.
How Puerto Rico compares for 26531
Across 109 of 109 payment localities, the facility rate for 26531 runs from $525.48 in Arkansas to $716.06 in Alaska. Puerto Rico pays $590.45. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Puerto Rico · this page$590.45
- Los Angeles, CA · California$632.39+$41.94
- Washington, DC area · District of Columbia$656.81+$66.36
- Miami, FL · Florida$675.50+$85.05
- Chicago, IL · Illinois$655.86+$65.41
- Manhattan, NY · New York$678.62+$88.17
- Alaska · Alaska$716.06+$125.61
Other areas in Puerto Rico first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | — | $532.40 |
| ArkansasArkansas | — | $525.48 |
| ArizonaArizona | — | $572.54 |
| Bakersfield, CACalifornia | — | $600.02 |
| Chico, CACalifornia | — | $595.86 |
| El Centro, CACalifornia | — | $596.11 |
| Fresno, CACalifornia | — | $595.86 |
| Hanford, CACalifornia | — | $595.86 |
| Madera, CACalifornia | — | $595.86 |
| Merced, CACalifornia | — | $595.86 |
| Modesto, CACalifornia | — | $595.86 |
| Napa, CACalifornia | — | $667.38 |
| Oxnard, CACalifornia | — | $626.63 |
| Redding, CACalifornia | — | $595.86 |
| Rest of CaliforniaCalifornia | — | $595.86 |
| Riverside, CACalifornia | — | $611.90 |
| Sacramento, CACalifornia | — | $619.22 |
| Salinas, CACalifornia | — | $616.80 |
| San Diego, CACalifornia | — | $626.96 |
| Marin County, CACalifornia | — | $698.59 |
| San Francisco, CACalifornia | — | $696.89 |
| San Benito County, CACalifornia | — | $715.14 |
| Santa Clara County, CACalifornia | — | $708.23 |
| San Luis Obispo, CACalifornia | — | $607.62 |
| Santa Cruz, CACalifornia | — | $629.47 |
| Santa Maria, CACalifornia | — | $617.92 |
| Santa Rosa, CACalifornia | — | $635.41 |
| Stockton, CACalifornia | — | $595.86 |
| Vallejo, CACalifornia | — | $664.94 |
| Visalia, CACalifornia | — | $595.86 |
| Yuba City, CACalifornia | — | $595.86 |
| ColoradoColorado | — | $597.98 |
| ConnecticutConnecticut | — | $625.00 |
| DelawareDelaware | — | $581.21 |
| Fort Lauderdale, FLFlorida | — | $631.96 |
| Rest of FloridaFlorida | — | $601.19 |
| Atlanta, GAGeorgia | — | $603.36 |
| Rest of GeorgiaGeorgia | — | $568.20 |
| Hawaii, Guam, HIHawaii | — | $604.71 |
| IowaIowa | — | $534.93 |
| IdahoIdaho | — | $540.08 |
| East St. Louis, ILIllinois | — | $616.77 |
| Rest of IllinoisIllinois | — | $592.41 |
| Suburban Chicago, ILIllinois | — | $635.85 |
| IndianaIndiana | — | $542.64 |
| KansasKansas | — | $537.24 |
| KentuckyKentucky | — | $553.60 |
| New Orleans, LALouisiana | — | $578.82 |
| Rest of LouisianaLouisiana | — | $554.64 |
| Metropolitan Boston, MAMassachusetts | — | $646.64 |
| Rest of MassachusettsMassachusetts | — | $596.82 |
| Baltimore area, MDMaryland | — | $624.19 |
| Rest of MarylandMaryland | — | $590.04 |
| Rest of MaineMaine | — | $547.49 |
| Southern Maine, MEMaine | — | $567.36 |
| Detroit, MIMichigan | — | $612.76 |
| Rest of MichiganMichigan | — | $570.81 |
| MinnesotaMinnesota | — | $561.09 |
| Metropolitan Kansas City, MOMissouri | — | $570.36 |
| Metropolitan St. Louis, MOMissouri | — | $575.16 |
| Rest of MissouriMissouri | — | $549.15 |
| MississippiMississippi | — | $537.18 |
| MontanaMontana | — | $588.09 |
| North CarolinaNorth Carolina | — | $551.90 |
| North DakotaNorth Dakota | — | $558.63 |
| NebraskaNebraska | — | $536.17 |
| New HampshireNew Hampshire | — | $593.18 |
| Northern New JerseyNew Jersey | — | $652.03 |
| Rest of New JerseyNew Jersey | — | $628.78 |
| New MexicoNew Mexico | — | $575.49 |
| NevadaNevada | — | $580.15 |
| NYC suburbs and Long Island, NYNew York | — | $699.49 |
| Poughkeepsie and northern NYC suburbs, NYNew York | — | $636.55 |
| Queens, NYNew York | — | $676.93 |
| Rest of New YorkNew York | — | $559.73 |
| OhioOhio | — | $564.79 |
| OklahomaOklahoma | — | $547.82 |
| Portland, OROregon | — | $610.05 |
| Rest of OregonOregon | — | $572.31 |
| Metropolitan Philadelphia, PAPennsylvania | — | $613.78 |
| Rest of PennsylvaniaPennsylvania | — | $563.02 |
| Rhode IslandRhode Island | — | $596.87 |
| South CarolinaSouth Carolina | — | $559.93 |
| South DakotaSouth Dakota | — | $555.14 |
| TennesseeTennessee | — | $540.25 |
| Austin, TXTexas | — | $598.91 |
| Beaumont, TXTexas | — | $560.04 |
| Brazoria, TXTexas | — | $576.90 |
| Dallas, TXTexas | — | $582.41 |
| Fort Worth, TXTexas | — | $580.32 |
| Galveston, TXTexas | — | $579.83 |
| Houston, TXTexas | — | $607.11 |
| Rest of TexasTexas | — | $569.41 |
| UtahUtah | — | $566.70 |
| VirginiaVirginia | — | $568.91 |
| Virgin Islands, VIUnited States Virgin Islands | — | $590.45 |
| VermontVermont | — | $560.87 |
| Rest of WashingtonWashington | — | $594.24 |
| King County, WAWashington | — | $654.42 |
| WisconsinWisconsin | — | $542.26 |
| West VirginiaWest Virginia | — | $573.80 |
| WyomingWyoming | — | $575.25 |
26531 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
How the 26531 rate is calculated
Each of 26531’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 · 26531
RVUs × geographic indexes × conversion factor
Work7.93
7.93 RVUs× 1.000 GPCI
Practice expense8.19
8.19 RVUs× 1.000 GPCI
Malpractice1.49
1.49 RVUs× 1.000 GPCI
Adjusted RVUs
17.6100
Conversion factor
$33.4009
Medicare rate
$588.19
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Puerto Rico inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
2,631
- Code
- 26531
- Physician work
- 7.93
- Practice expense
- 8.19
- Malpractice
- 1.49
GPCI2026.csv
91
- Locality
- Puerto Rico
- Physician work
- 1.000
- Practice expense
- 1.011
- Malpractice
- 0.985
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 7.93 | × 1.000 | 7.9300 |
| Practice expense | 8.19 | × 1.011 | 8.2801 |
| Malpractice | 1.49 | × 0.985 | 1.4676 |
| Total RVUs | 17.6777 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Puerto Rico$590.45
Facility: (7.93 × 1 + 8.19 × 1.011 + 1.49 × 0.985) × $33.4009 = $590.45
Payment rules and modifiers for 26531
26531 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 26531
Knuckle arthroplasty, with implant
| 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) | 0 | The 150% bilateral adjustment doesn’t apply. |
| 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 · 26531
Knuckle arthroplasty, with implant
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 51 · payment effect
With and without the modifier
26531 without 51 · national facility
$588.19
Knuckle arthroplasty, with implant
26531-51 · Second procedure: 50%
$294.10
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
How 26531 has changed in Puerto Rico
26531 · Office / nonfacility
Rate unavailable
Effective 2026-10-01
A rate is unavailable in one of these releases, so a change cannot be calculated.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | Not available in this setting | $590.45 | RVU26D |
| 2026-07-01 | Not available in this setting | $590.45 | RVU26C |
| 2026-04-01 | Not available in this setting | $590.45 | RVU26B |
| 2026-01-01 | Not available in this setting | $590.45 | RVU26A |
| 2025-10-01 | Not available in this setting | $633.40 | RVU25D |
| 2025-07-01 | Not available in this setting | $633.40 | RVU25C |
| 2025-04-01 | Not available in this setting | $633.40 | RVU25B |
| 2025-01-01 | Not available in this setting | $633.40 | RVU25A |
| 2024-10-01 | Not available in this setting | $643.78 | RVU24D |
| 2024-07-01 | Not available in this setting | $643.78 | RVU24C |
| 2024-04-01 | Not available in this setting | $643.78 | RVU24B |
| 2024-03-09 | Not available in this setting | $643.78 | RVU24AR |
| 2024-01-01 | Not available in this setting | $633.27 | RVU24A |
| 2023-10-01 | Not available in this setting | $649.68 | RVU23D |
| 2023-07-01 | Not available in this setting | $647.92 | RVU23C |
| 2023-04-01 | Not available in this setting | $647.92 | RVU23B |
| 2023-01-01 | Not available in this setting | $647.92 | RVU23A |
| 2022-10-01 | Not available in this setting | $652.41 | RVU22D |
| 2022-07-01 | Not available in this setting | $652.41 | RVU22C |
| 2022-04-01 | Not available in this setting | $652.41 | RVU22B |
| 2022-01-01 | Not available in this setting | $652.41 | RVU22A |
| 2021-10-01 | Not available in this setting | $651.52 | RVU21D |
| 2021-07-01 | Not available in this setting | $651.52 | RVU21C |
| 2021-04-01 | Not available in this setting | $651.52 | RVU21B |
| 2021-01-01 | Not available in this setting | $651.52 | RVU21A |
| 2020-10-01 | Not available in this setting | $653.97 | RVU20D |
| 2020-07-01 | Not available in this setting | $653.97 | RVU20C |
| 2020-04-01 | Not available in this setting | $653.97 | RVU20B |
| 2020-01-01 | Not available in this setting | $653.97 | RVU20A |
| 2019-10-01 | Not available in this setting | $648.87 | RVU19D |
| 2019-07-01 | Not available in this setting | $648.87 | RVU19C |
| 2019-04-01 | Not available in this setting | $648.87 | RVU19B |
| 2019-01-01 | Not available in this setting | $648.87 | RVU19A |
| 2018-10-01 | Not available in this setting | $647.42 | RVU18D |
| 2018-07-01 | Not available in this setting | $647.42 | RVU18C |
| 2018-04-01 | Not available in this setting | $647.42 | RVU18B |
| 2018-01-01 | Not available in this setting | $647.42 | RVU18AR1 |
| 2017-10-01 | Not available in this setting | $579.86 | RVU17D |
| 2017-07-01 | Not available in this setting | $579.86 | RVU17C |
| 2017-04-01 | Not available in this setting | $579.86 | RVU17B |
| 2017-01-01 | Not available in this setting | $579.86 | RVU17A |
| 2016-10-01 | Not available in this setting | $514.76 | RVU16D |
| 2016-07-01 | Not available in this setting | $514.76 | RVU16C |
| 2016-04-01 | Not available in this setting | $514.76 | RVU16B |
| 2016-01-01 | Not available in this setting | $514.76 | RVU16A |
| 2015-10-01 | Not available in this setting | $516.36 | RVU15D |
| 2015-07-01 | Not available in this setting | $516.36 | RVU15C |
| 2015-04-01 | Not available in this setting | $513.79 | RVU15B |
| 2015-01-01 | Not available in this setting | $513.79 | RVU15A |
| 2014-10-01 | Not available in this setting | $507.18 | RVU14D |
| 2014-07-01 | Not available in this setting | $507.18 | RVU14C |
| 2014-04-01 | Not available in this setting | $507.18 | RVU14B |
| 2014-01-01 | Not available in this setting | $507.18 | RVU14A |
| 2013-10-01 | Not available in this setting | $493.68 | RVU13D |
| 2013-07-01 | Not available in this setting | $493.68 | RVU13C |
| 2013-04-01 | Not available in this setting | $493.68 | RVU13B |
| 2013-01-01 | Not available in this setting | $493.68 | RVU13AR |
Where the Puerto Rico rate applies
Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.
- Aceitunas
- Adjuntas
- Aguada
- Aguadilla
- Aguas Buenas
- Aguas Claras
- Aguilita
- Aibonito
26531 billing questions
How does this differ from 26530?
Use 26531 when an implant is placed during MCP joint arthroplasty. Code 26530 describes MCP arthroplasty without an implant.
Can this code be used for an implant at a finger joint?
No. This code is for a metacarpophalangeal joint. Code 26536 describes implant arthroplasty at an interphalangeal joint.
Should modifier 50 be reported when both hands are treated?
No. CMS identifies bilateral adjustment as inappropriate for this code. Follow the applicable reporting instructions for the procedures performed on each hand.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care for 90 days after surgery.
Can an assistant surgeon or co-surgeon be reported?
Assistant-at-surgery payment may be available. Co-surgeon payment requires 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
Show the CMS file lines behind this rate
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