Billing code 26185: SesamoidectomyMedicare rate & RVUs

Medicare pays $547.44 for 26185 nationally in a facility.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 26185 covers

A hand or orthopedic surgeon removes a sesamoid bone in the thumb or a finger through an operative approach. These small bones lie near a joint and may be removed when a documented problem, such as persistent symptoms from a fractured or painful sesamoid, warrants surgery. The procedure is generally performed in an operating room or ambulatory surgery setting; the operative report should identify the digit, the sesamoid treated, and the reason for excision.

Report 26185 for the sesamoidectomy itself, not for removal of a tendon or a separate lesion in the tendon sheath. The operative note should support that a sesamoid bone was excised and distinguish the work from joint reconstruction or treatment of another bone lesion. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When bilateral procedures are performed, modifier 50 is paid at 150%. For multiple procedures in the same session, the highest-valued procedure is paid in full and others at 50%. Assistant-at-surgery services 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 26185 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

26185 rates by state

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

How the 26185 rate is calculated

Each of 26185’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.

Payment rules and modifiers for 26185

26185 has a 90-day global period: related visits in that window are included in the surgery payment.

What modifiers do to the payment

When to use modifier 50

26185 compared with similar codes

How to choose

26200Bone lesion removal

Choose 26185 for removal of a thumb or finger sesamoid. Code 26200 concerns a benign bone lesion in a finger phalanx.

26160Tendon sheath excision

Code 26160 concerns a lesion of a tendon sheath or joint capsule. Use 26185 when the structure removed is a sesamoid bone.

26530Knuckle arthroplasty

Code 26530 addresses metacarpophalangeal joint reconstruction; 26185 removes a sesamoid and does not by itself describe joint reconstruction.

26535Finger joint surgery

Code 26535 addresses interphalangeal joint reconstruction. Code 26185 applies when the operation removes a thumb or finger sesamoid.

Codes related to 26185

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

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

Open CMS sourceHow we calculate rates