Billing code 26116: Hand tumor excisionMedicare rate & RVUs in Oregon
Reports excision of a small soft-tissue tumor beneath the fascia of the hand or finger, selected by depth and tumor size.
CMS doesn’t publish an office rate for 26116 in Oregon.
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 26116 covers
A hand surgeon, orthopedic surgeon, or plastic surgeon uses this code for excision of a soft-tissue tumor located beneath the fascia in the hand or a finger, with a tumor measuring less than 1.5 cm. The service involves surgically removing the mass; the operative report should establish its hand or finger location, deep position, and size. A specimen may be submitted for pathologic examination, but the code selection is based on the excision’s site, depth, and size rather than the eventual diagnosis.
Choose this code for a deep tumor under 1.5 cm, not a superficial mass or a larger deep tumor. Document the tumor’s dimensions and its relationship to the fascia. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of 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% multiple-procedure reduction. Modifier 50 is inappropriate; assistant-at-surgery payment is restricted, and 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.
Where 26116 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | Unavailable | $512.66 |
| Rest Of Oregon | Unavailable | $480.67 |
How the 26116 rate is calculated
Each of 26116’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 · 26116
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 6.57Practice expense 6.97Malpractice 1.25
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 26116
26116 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 26116
Hand tumor excision
| 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) | 1 | Not paid (statutory restriction). |
| 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 · 26116
Hand tumor excision
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
26116 without 51 · national facility
$494.00
Hand tumor excision
26116-51 · Second procedure: 50%
$247.00
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%).
26116 compared with similar codes
Compare codes
26116 vs 26115 vs 26113 vs 26160 vs 26117: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 26115Hand mass excision
- Use 26115 when the mass is subcutaneous. Use 26116 when it lies beneath the fascia; both represent the under-1.5-cm size level.
- 26113Hand tumor excision
- Both describe deep hand or finger tumor excision, but 26113 is for a tumor measuring 1.5 cm or more.
- 26160Tendon sheath excision
- 26160 addresses a lesion arising from a tendon sheath or joint capsule. This code is for a deep soft-tissue tumor not classified by that specific origin.
- 26117Hand tumor resection
- 26117 describes radical resection of a hand tumor under 3 cm. Choose based on the operative extent and technique, not size alone.
26116 billing questions
How does this differ from 26115?
26116 is for a tumor beneath the fascia; 26115 is for a subcutaneous tumor. Both codes distinguish tumors smaller than 1.5 cm from larger lesions through separate sibling codes.
When should 26113 be selected instead?
Use 26113 for a deep hand or finger tumor measuring 1.5 cm or more. The size boundary is based on the tumor, not the length of the incision.
Is a tendon-sheath lesion reported with this code?
A lesion specifically excised from a tendon sheath may fit 26160 rather than a general deep soft-tissue tumor excision. The operative findings should identify the lesion’s origin.
Can modifier 50 be used for tumors in both hands?
No. CMS identifies bilateral adjustment as inappropriate for this code. The descriptor or anatomy makes modifier 50 an unsuitable reporting approach.
What postoperative care is included in the payment?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. The CMS multiple-procedure reduction applies when other procedures are performed in the same session.
Can an assistant or co-surgeon be paid for this procedure?
CMS applies a statutory restriction to assistant-at-surgery payment for this code. Co-surgeons and team surgery are not permitted.
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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