Billing code 26650: Thumb fracture-dislocationMedicare rate & RVUs in Oregon
Reports closed reduction of a thumb carpometacarpal fracture-dislocation, such as a Bennett-type injury, when the physician manipulates the bones into alignment.
CMS doesn’t publish an office rate for 26650 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 26650 covers
This service treats a fracture-dislocation at the base of the thumb metacarpal where it meets the wrist-side carpal bone. A hand or orthopedic surgeon manipulates the injured bones back into alignment without surgically opening the joint; a Bennett-type injury is a typical example. Treatment is commonly performed in an operating room or other procedural setting, with imaging used to assess alignment as appropriate.
Report 26650 when the provider performs manipulation to reduce the thumb carpometacarpal fracture-dislocation. The record should identify the injury and document the reduction; a thumb metacarpal fracture elsewhere in the bone is not this joint injury. The code has a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and others at 50%. Bilateral reporting with modifier 50 is paid at 150%. 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 26650 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | Unavailable | $493.55 |
| Rest Of Oregon | Unavailable | $459.26 |
How the 26650 rate is calculated
Each of 26650’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 · 26650
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 5.22Practice expense 7.83Malpractice 1.04
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 26650
26650 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 26650
Thumb fracture-dislocation
| 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) | 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 · 26650
Thumb fracture-dislocation
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
26650 without 50 · national facility
$470.62
Thumb fracture-dislocation
26650-50 · Bilateral: 150%
$705.93
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).
26650 compared with similar codes
Compare codes
26650 vs 26645 vs 26665 vs 26641 vs 26605: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 26645Thumb fracture
- Both address a thumb carpometacarpal fracture-dislocation by closed treatment. Choose 26650 when manipulation is performed; 26645 is for treatment without manipulation.
- 26665Thumb fracture-dislocation repair
- 26650 is closed reduction by manipulation. 26665 applies when the fracture-dislocation is treated through an open approach.
- 26641Thumb dislocation
- 26641 is for a thumb carpometacarpal dislocation without a fracture. Use 26650 for a fracture-dislocation requiring closed manipulation.
- 26605Metacarpal fracture
- 26605 treats a metacarpal fracture with manipulation, rather than the thumb carpometacarpal fracture-dislocation addressed by 26650.
26650 billing questions
When should 26650 be chosen over 26645?
Use 26650 when the physician manipulates a thumb carpometacarpal fracture-dislocation to restore alignment. Code 26645 is the related closed-treatment option when manipulation is not performed.
How does 26650 differ from 26665?
26650 describes closed reduction by manipulation. Choose 26665 when the thumb carpometacarpal fracture-dislocation is treated through an open surgical approach.
Can a separate reduction or manipulation service be billed with 26650?
The manipulation is part of the closed fracture-dislocation treatment represented by 26650; do not separately report that same reduction as another service.
What documentation supports reporting 26650?
Document the thumb carpometacarpal fracture-dislocation and the physician's manipulation to reduce it. The record should distinguish this joint injury from a fracture elsewhere in the thumb metacarpal.
How are bilateral cases and other same-session procedures handled?
For bilateral treatment, modifier 50 is paid at 150%. When other procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50%.
Is an assistant or co-surgeon payable for 26650?
Assistant-at-surgery payment is subject to a statutory restriction 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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