Billing code 26540: Ligament repairMedicare rate & RVUs in Missouri
Reports operative repair of a collateral ligament at a finger or thumb MCP or IP joint, such as repair of an injured thumb MCP ligament.
CMS doesn’t publish an office rate for 26540 in Missouri.
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 26540 covers
This surgery repairs a collateral ligament that stabilizes a metacarpophalangeal (MCP) or interphalangeal (IP) joint in the hand. A typical example is direct repair of a torn thumb MCP collateral ligament after an injury; the service may also involve another finger joint. An orthopedic or hand surgeon performs the operation, usually in an operating room, using the operative approach and repair technique appropriate to the ligament injury.
Report the code when the surgeon repairs the joint’s collateral ligament without the graft-based work represented by related codes. The operative report should identify the joint and side, describe the ligament injury, and document the repair performed. The service has a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. Assistant-at-surgery and co-surgeon payment require supporting documentation; 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 26540 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City | Unavailable | $652.63 |
| Metropolitan St. Louis | Unavailable | $659.16 |
| Rest Of Missouri | Unavailable | $619.94 |
How the 26540 rate is calculated
Each of 26540’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 · 26540
RVUs × geographic indexes × conversion factor
Work6.44
6.44 RVUs× 1.000 GPCI
Practice expense12.66
12.66 RVUs× 1.000 GPCI
Malpractice1.24
1.24 RVUs× 1.000 GPCI
Adjusted RVUs
20.3400
Conversion factor
$33.4009
Medicare rate
$679.37
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 26540
26540 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 26540
Ligament repair
| 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) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| 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 · 26540
Ligament repair
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 51 · payment effect
With and without the modifier
26540 without 51 · national facility
$679.37
Ligament repair
26540-51 · Second procedure: 50%
$339.69
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
26540 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 26541Ligament repair
- 26540 describes collateral-ligament repair without graft-based work. Choose 26541 when the documented procedure includes the graft-based repair represented by that code.
- 26542Joint ligament repair
- This is a related graft-based hand-joint repair code. Distinguish it from 26540 by the graft work documented in the operative report.
- 26545Finger joint reconstruction
- 26545 describes finger-joint reconstruction, rather than the collateral-ligament repair represented by 26540. Select based on the procedure actually performed.
26540 billing questions
When should 26540 be chosen over a graft-based repair code?
Use 26540 for repair of the collateral ligament without the graft-based work described by 26541 or 26542. The operative report should support the technique actually performed.
Can this code be reported for a thumb MCP ligament repair?
Yes. Direct repair of an injured thumb MCP collateral ligament is a typical example; document the joint, side, injury, and repair.
Should modifier 50 be used for repairs on both hands?
No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this code.
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 surgeon payable?
Assistant-at-surgery payment is allowed only when medical necessity is documented. Co-surgeon payment also requires supporting documentation.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full; other procedures in that session are subject to the standard multiple-procedure 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 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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