No office rate
Choose 26185 for removal of a thumb or finger sesamoid. Code 26200 concerns a benign bone lesion in a finger phalanx.
On this page
CMS RVU26D · Effective 2026-10-01
26185 Sesamoidectomy Medicare reimbursement rates in Delaware
Report this procedure when a hand surgeon removes a symptomatic sesamoid bone in a thumb or finger, such as for persistent pain or nonunion. Compare 26185 office and facility rates across CMS payment localities in Delaware.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 26185 in Delaware?
Delaware has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$540.50
1 of 1 localities have a supported rate.
Payment area: Delaware
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Hand surgery
About 26185: Finger sesamoid bone excision
Report this procedure when a hand surgeon removes a symptomatic sesamoid bone in a thumb or finger, such as for persistent pain or nonunion.
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.
CMS billing rules for 26185
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral procedure with modifier 50 is paid at 150%.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU6.36 · 39%
- Practice expense (office) RVU8.69 · 53%
- Malpractice RVU1.34 · 8%
42
Medicare services in 2024 · #5461 by national volume
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.
26185 compared with similar codes
Office rates for Delaware, from the same CMS release.
$649.79
Code 26160 concerns a lesion of a tendon sheath or joint capsule. Use 26185 when the structure removed is a sesamoid bone.
No office rate
Code 26530 addresses metacarpophalangeal joint reconstruction; 26185 removes a sesamoid and does not by itself describe joint reconstruction.
No office rate
Code 26535 addresses interphalangeal joint reconstruction. Code 26185 applies when the operation removes a thumb or finger sesamoid.
Compare 26185 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Delaware →
Office / nonfacility
Unavailable
Facility
$540.50
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 26185 in Delaware.
PPRRVU2026_Oct_nonQPP.csv
2,561
- Code
- 26185
- Physician work
- 6.36
- Practice expense
- 8.69
- Malpractice
- 1.34
GPCI2026.csv
40
- Locality
- Delaware
- Physician work
- 1.005
- Practice expense
- 0.988
- Malpractice
- 0.899
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 6.36 | × 1.005 | 6.3918 |
| Practice expense | 8.69 | × 0.988 | 8.5857 |
| Malpractice | 1.34 | × 0.899 | 1.2047 |
| Total RVUs | 16.1822 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Delaware$540.50
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 6.36 | 1.005 |
| Practice expense | 8.69 | 0.988 |
| Malpractice | 1.34 | 0.899 |
(6.36 × 1.005 + 8.69 × 0.988 + 1.34 × 0.899) × $33.4009 = $540.50
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
26185 billing questions
When is 26185 the right choice instead of a finger bone lesion code?
Use 26185 when the excised structure is a sesamoid bone in the thumb or finger. A code such as 26200 addresses a benign bone lesion in a phalanx, not removal of a sesamoid.
Does 26185 include removal of a tendon sheath lesion?
No. The code describes removal of a sesamoid bone; a tendon sheath lesion is a different target and may involve 26160 when that procedure is performed and separately reportable.
What documentation supports reporting 26185?
Document the affected digit, the sesamoid removed, the indication for surgery, and the operative work confirming excision. The note should distinguish the sesamoid from adjacent joint, tendon, and other bone structures.
How should bilateral sesamoidectomies be reported?
CMS identifies 26185 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. Related routine follow-up during that period is part of the surgical package.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery services may be paid. Co-surgeon payment requires supporting documentation, and CMS does not permit team surgery for this code.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
2,55826160,,Remove tendon sheath lesion,A,,3.48,15.55,,5.10,,0.66,19.69,9.24,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,55926170,,Removal of palm tendon each,A,,4.79,6.02,NA,6.02,,0.92,11.73,11.73,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,56026180,,Removal of finger tendon,A,,5.22,6.69,NA,6.69,,1.00,12.91,12.91,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,56126185,,Remove finger bone,A,,6.36,8.69,NA,8.69,,1.34,16.39,16.39,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,56226200,,Remove hand bone lesion,A,,5.51,6.26,NA,6.26,,1.08,12.85,12.85,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,56326205,,Remove/graft bone lesion,A,,7.73,7.88,NA,7.88,,1.64,17.25,17.25,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,56426210,,Removal of finger lesion,A,,5.19,6.64,NA,6.64,,1.00,12.83,12.83,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899
4109102,FL,03,FORT LAUDERDALE,1.000,1.013,1.808
4209102,FL,04,MIAMI,1.000,1.041,2.529
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503