Billing code 26205: Bone lesion surgeryMedicare rate & RVUs in Texas
Reports curettage or excision of a benign cyst or tumor in a metacarpal when the resulting bone defect is filled with an autologous graft.
CMS doesn’t publish an office rate for 26205 in Texas.
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 26205 covers
A hand surgeon treats a benign bone cyst or tumor in a metacarpal by removing or curetting the lesion and placing the patient’s own bone graft in the resulting defect. The graft is harvested as part of the service. This procedure is typically performed in an operating room, with the operative report identifying the metacarpal and describing lesion removal and graft placement.
Select this code when the treated bone is a metacarpal and an autologous graft is used; the no-graft code 26200 is the nearby choice when grafting is not performed. Document the lesion, its site, the removal technique, and graft use and harvest. Medicare 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% multiple-procedure reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this service, and co-surgeon and team-surgery billing 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 26205 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | Unavailable | $585.70 |
| Beaumont | Unavailable | $548.59 |
| Brazoria | Unavailable | $563.81 |
| Dallas | Unavailable | $569.66 |
| Fort Worth | Unavailable | $567.74 |
| Galveston | Unavailable | $566.97 |
| Houston | Unavailable | $596.98 |
| Rest Of Texas | Unavailable | $557.43 |
How the 26205 rate is calculated
Each of 26205’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 · 26205
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 7.73Practice expense 7.88Malpractice 1.64
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 26205
26205 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 26205
Bone lesion surgery
| 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 · 26205
Bone lesion surgery
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
26205 without 51 · national facility
$576.17
Bone lesion surgery
26205-51 · Second procedure: 50%
$288.09
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%).
26205 compared with similar codes
Compare codes
26205 vs 26200 vs 26215 vs 26230: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 26200Bone lesion removal
- Both address a metacarpal bone lesion, but 26205 includes autologous graft placement and harvest; 26200 is used when grafting is not performed.
- 26215Finger bone lesion
- This code is for a metacarpal. Code 26215 is the corresponding grafted lesion procedure for a finger phalanx.
- 26230Hand bone excision
- Code 26230 describes partial removal of metacarpal bone. Choose 26205 when the service is lesion curettage or excision with an autologous graft.
26205 billing questions
When should 26205 be chosen over 26200?
Use 26205 for a metacarpal lesion when an autologous bone graft is placed after lesion removal. Code 26200 is the nearby option when no graft is used.
Can the bone graft harvest be billed separately?
The graft harvest is included in this service. The operative documentation should establish that the graft was autologous and placed in the metacarpal defect.
Does modifier 50 apply if lesions are treated on both hands?
No. CMS identifies bilateral adjustment as inappropriate for this code; modifier 50 should not be used.
How does the 90-day global period affect follow-up visits?
The global period includes the day-before preoperative visit and 90 days of related postoperative care. Those included services are part of the surgical package.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction. Medicare does not pay an assistant at surgery 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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