No office rate
Use 26615 for open treatment of an acute metacarpal fracture. Use 26546 when the fracture has become an established nonunion or malunion requiring repair.
On this page
CMS RVU26D · Effective 2026-10-01
26546 Metacarpal repair Medicare reimbursement rates in Hawaii
Surgical repair of a metacarpal fracture that has failed to unite or healed in a deformity, with bone grafting when needed. Compare 26546 office and facility rates across CMS payment localities in Hawaii.
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 26546 in Hawaii?
Hawaii 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
$1043.46
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
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 26546: Metacarpal nonunion or malunion repair
Surgical repair of a metacarpal fracture that has failed to unite or healed in a deformity, with bone grafting when needed.
A hand surgeon uses this service to address a metacarpal fracture that has not united or has healed in a position that impairs hand function. The operation may involve preparing the fracture site, restoring alignment, and stabilizing the bone; bone graft may be used when needed. Typical cases include a symptomatic fracture nonunion or a malunion that affects finger alignment, grip, or hand use. These repairs are generally performed in an operating room.
Report the code for repair of the established metacarpal nonunion or malunion, rather than treatment of an acute fracture. The operative note should identify the metacarpal, describe the nonunion or deformity and its functional significance, and document the repair and fixation; include graft use when performed. Bone graft use is included in this service. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 applies to bilateral reporting, paid at 150%. Assistant-at-surgery payment may be made; co-surgeons and team surgery are not permitted.
CMS billing rules for 26546
- 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 not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU10.56 · 36%
- Practice expense (office) RVU17.16 · 58%
- Malpractice RVU2.02 · 7%
177
Medicare services in 2024 · #4433 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.
26546 compared with similar codes
Office rates for Hawaii, from the same CMS release.
$367.75
Code 26600 describes closed treatment without manipulation of an acute metacarpal fracture; 26546 addresses repair of an established nonunion or malunion.
$403.13
Code 26605 is closed treatment with manipulation for an acute metacarpal fracture. It is not the repair code for a fracture that has failed to unite or healed in a deformity.
No office rate
Code 26565 is for corrective metacarpal osteotomy. Choose 26546 when the operative problem is an established metacarpal fracture nonunion or malunion.
Compare 26546 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
Hawaii, Guam →
Office / nonfacility
Unavailable
Facility
$1043.46
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 26546 in Hawaii, Guam.
PPRRVU2026_Oct_nonQPP.csv
2,638
- Code
- 26546
- Physician work
- 10.56
- Practice expense
- 17.16
- Malpractice
- 2.02
GPCI2026.csv
46
- Locality
- Hawaii, Guam
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 10.56 | × 1.000 | 10.5600 |
| Practice expense | 17.16 | × 1.137 | 19.5109 |
| Malpractice | 2.02 | × 0.579 | 1.1696 |
| Total RVUs | 31.2405 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Hawaii, Guam$1043.46
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 10.56 | 1 |
| Practice expense | 17.16 | 1.137 |
| Malpractice | 2.02 | 0.579 |
(10.56 × 1 + 17.16 × 1.137 + 2.02 × 0.579) × $33.4009 = $1043.46
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.
26546 billing questions
How is this different from open treatment of an acute metacarpal fracture?
This code is for repair of an established nonunion or malunion. Open treatment of an acute metacarpal fracture is considered under 26615.
Is bone grafting separately required to report this code?
No. The repair includes bone grafting when it is performed; document the graft use and the repair in the operative note.
What documentation supports reporting this repair?
Document the metacarpal involved, the established nonunion or malunion, the resulting symptoms or functional problem, and the operative correction and stabilization.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant surgeon be reported?
CMS permits payment for an assistant at surgery for this code. Co-surgeon and team-surgery payment are not permitted.
How does CMS handle bilateral procedures or other procedures in the same session?
Bilateral reporting with modifier 50 is paid at 150%. For multiple procedures in the same session, the highest-valued procedure is paid in full and the others are subject to a 50% reduction.
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.
2,63526541,,Repair hand joint with graft,A,,8.59,13.70,NA,13.70,,1.65,23.94,23.94,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,63626542,,Repair hand joint with graft,A,,6.78,12.78,NA,12.78,,1.30,20.86,20.86,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,63726545,,Reconstruct finger joint,A,,6.93,12.94,NA,12.94,,1.31,21.18,21.18,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,63826546,,Repair nonunion hand,A,,10.56,17.16,NA,17.16,,2.02,29.74,29.74,0,090,0.10,0.69,0.21,2,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,63926548,,Reconstruct finger joint,A,,8.01,13.39,NA,13.39,,1.53,22.93,22.93,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,64026550,,Pollicization digit,A,,21.14,20.42,NA,20.42,,4.50,46.06,46.06,0,090,0.10,0.69,0.21,2,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,64126551,,Great toe-hand transfer,A,,47.27,31.71,NA,31.71,,10.10,89.08,89.08,0,090,0.10,0.69,0.21,2,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503
4410212,GA,01,ATLANTA,1.003,1.016,1.201
4510212,GA,99,REST OF GEORGIA,1.000,0.892,1.192
4601212,HI,01,"HAWAII, GUAM",1.000,1.137,0.579
4702202,ID,00,IDAHO,1.000,0.920,0.473
4806102,IL,16,CHICAGO,1.007,1.005,2.295
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014