Billing code 26665: Thumb fracture-dislocation repairMedicare rate & RVUs

Medicare pays $577.84 for 26665 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 26665 covers

This code covers open surgical treatment of a fracture-dislocation where the base of the thumb metacarpal is displaced at its joint with the trapezium. An orthopedic or hand surgeon typically exposes and reduces the joint and stabilizes the injury as needed, often in an operating room. The key distinction is a thumb carpometacarpal fracture-dislocation treated through an open approach, rather than an isolated thumb metacarpal fracture or a dislocation without fracture.

Choose the code based on the documented injury and operative approach. The operative report should identify the fracture-dislocation, the thumb carpometacarpal joint, the open reduction, and any fixation performed. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment is statutorily restricted; 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.

Where 26665 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

26665 rates by state

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

How the 26665 rate is calculated

Each of 26665’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 26665

26665 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

26665 compared with similar codes

How to choose

26645Thumb fracture

Use 26645 for closed treatment of a thumb carpometacarpal fracture-dislocation without manipulation; use 26665 when the fracture-dislocation is treated through an open approach.

26650Thumb fracture-dislocation

Code 26650 describes closed treatment with manipulation. Open operative treatment of the thumb carpometacarpal fracture-dislocation is reported with 26665.

26641Thumb dislocation

Code 26641 is for thumb carpometacarpal dislocation without a fracture. This code requires a fracture-dislocation treated openly.

26615Metacarpal fracture

Code 26615 applies to open treatment of a metacarpal fracture; 26665 applies when the thumb carpometacarpal joint is involved in a fracture-dislocation.

Codes related to 26665

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