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Billing code 26105: Joint biopsyMedicare rate & RVUs

Open biopsy of metacarpophalangeal joint lining, reported when tissue sampling is needed to evaluate unexplained synovitis, suspected infection, or another joint process.

CMS RVU26DEffective Oct 1, 2026109 payment localities111 Medicare services in 2024

Medicare pays $340.36 for 26105 nationally in a facility.

Medicare rate · 26105

Joint biopsy

Swap in your local Medicare rate.

Work RVUs
3.73
Total RVUs
10.19
Global days
090

National rate · 2026

$340.36

Facility setting, before claim adjustments.

See every locality for 26105 → · Billed by an NP, PA or therapist? →

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 10 sections
  1. Medicare rate
  2. What 26105 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 26105 covers

This service involves surgically opening a metacarpophalangeal joint in the hand and taking a tissue sample from its lining for diagnostic evaluation. Hand and orthopedic surgeons may perform it when examination or imaging identifies abnormal joint-lining tissue and a tissue diagnosis is needed, such as in an evaluation of unexplained synovitis or suspected infection. The code is specific to the metacarpophalangeal joint, where a finger meets the hand.

Select the code based on the joint sampled: this code is for a metacarpophalangeal joint, not a carpometacarpal or interphalangeal joint. The operative report should identify the joint and side, describe the open biopsy, and document the indication and tissue obtained. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. In a same-session multiple-procedure claim, the highest-valued procedure is paid in full and other procedures are subject to the standard reduction. Modifier 50 applies to a bilateral procedure, paid at 150%. An assistant is paid only with documentation of medical necessity; co-surgeons and team surgery are 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 26105 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

26105 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$305.13
Alaska*Unavailable$402.94
ArizonaUnavailable$330.65
ArkansasUnavailable$300.74
AtlantaUnavailable$349.12
AustinUnavailable$348.52
BakersfieldUnavailable$350.42
Baltimore/Surr. CntysUnavailable$362.48
BeaumontUnavailable$321.44
BrazoriaUnavailable$333.77

26105 rates by state

Office rate range in each state. Select a state to see its payment localities.

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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
26105 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 26105 rate is calculated

Each of 26105’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 · 26105

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 3.73Practice expense 5.66Malpractice 0.80

10.1900 adjusted RVUs×$33.4009 conversion factor=$340.36

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 26105

26105 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 26105

Joint biopsy

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
Assistant at surgery (80/81/82/AS)0Not paid without supporting documentation.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.69/0.21Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 26105

Joint biopsy

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.

  • 24 Unrelated E/M visit by the same physician
  • 79 Unrelated procedure (starts its own global period)
  • 58 Staged, more extensive, or therapy procedure that was planned
  • 78 Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 50 · payment effect

With and without the modifier

26105 without 50 · national facility

$340.36

Joint biopsy

26105-50 · Bilateral: 150%

$510.54

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).

When to use modifier 50

26105 compared with similar codes

Compare codes

26105 vs 26100 vs 26110 vs 20600 vs 26130: national Medicare rates

Swap in your local Medicare rate.

  • 26105
    Joint biopsy · 3.73 wRVU
    —
  • 26100
    Joint biopsy · 3.7 wRVU
    —
  • 26110
    Joint biopsy · 3.56 wRVU
    —
  • 20600
    Joint aspiration/injection · 0.64 wRVU
    $56.11
  • 26130
    Wrist synovectomy · 5.45 wRVU
    —

How to choose

26100Joint biopsy
26100 is for biopsy of a carpometacarpal joint. Use 26105 for a metacarpophalangeal joint at the base of a finger.
26110Joint biopsy
26110 applies to an interphalangeal joint within a finger; 26105 applies where the finger meets the hand.
20600Joint aspiration/injection
20600 describes small-joint aspiration or injection. It does not describe surgically opening the joint to obtain a tissue biopsy.
26130Wrist synovectomy
26130 describes removal of wrist-joint lining, not biopsy of a metacarpophalangeal joint.

Codes related to 26105

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 26105
CodeHow it relatesNational office range
Same family
26100Joint biopsyBiopsy of a carpometacarpal joint rather than a metacarpophalangeal joint.No office rate
26110Joint biopsyBiopsy of an interphalangeal joint within a finger.No office rate
Used instead
20600Joint aspiration/injectionSmall-joint aspiration or injection when fluid sampling or injection, rather than open tissue biopsy, is performed.$50.30–$71.40

26105 billing questions

How does this differ from 26110?

26105 is for biopsy of a metacarpophalangeal joint, where a finger meets the hand. 26110 is for biopsy of an interphalangeal joint within a finger.

Is this the same as aspirating a finger joint?

No. This code describes an open tissue biopsy of the joint lining. Arthrocentesis code 20600 is used for aspiration or injection of a small joint or bursa.

What documentation supports reporting 26105?

Document the specific metacarpophalangeal joint and side, the clinical reason for tissue sampling, the open biopsy performed, and the tissue obtained.

Can modifier 50 be reported when both sides are biopsied?

CMS identifies this as a bilateral procedure; modifier 50 is paid at 150% when the procedure is performed bilaterally.

What postoperative care is included?

The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.

When is an assistant at surgery payable?

CMS pays an assistant at surgery only when the claim is supported by documentation of medical necessity.

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
RVUs for 26105PPRRVU2026_Oct_nonQPP.csv, line 2,543 (RVU26D)

Open CMS sourceHow we calculate rates

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