Billing code 26105: Joint biopsyMedicare rate & RVUs in Delaware
Open biopsy of metacarpophalangeal joint lining, reported when tissue sampling is needed to evaluate unexplained synovitis, suspected infection, or another joint process.
CMS doesn’t publish an office rate for 26105 in Delaware.
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 9 sections
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.
26105 in Delaware
| Payment locality | Office | Facility |
|---|---|---|
| Delaware | Unavailable | $336.01 |
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
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
| 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) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| 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 · 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.
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).
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.
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.
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
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