Billing code 26546: Metacarpal repairMedicare rate & RVUs in Texas
Surgical repair of a metacarpal fracture that has failed to unite or healed in a deformity, with bone grafting when needed.
CMS doesn’t publish an office rate for 26546 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 26546 covers
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.
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 26546 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 | $1,019.60 |
| Beaumont | Unavailable | $936.97 |
| Brazoria | Unavailable | $976.16 |
| Dallas | Unavailable | $984.64 |
| Fort Worth | Unavailable | $979.79 |
| Galveston | Unavailable | $980.55 |
| Houston | Unavailable | $1,017.52 |
| Rest Of Texas | Unavailable | $957.57 |
How the 26546 rate is calculated
Each of 26546’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 · 26546
RVUs × geographic indexes × conversion factor
Work10.56
10.56 RVUs× 1.000 GPCI
Practice expense17.16
17.16 RVUs× 1.000 GPCI
Malpractice2.02
2.02 RVUs× 1.000 GPCI
Adjusted RVUs
29.7400
Conversion factor
$33.4009
Medicare rate
$993.34
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 26546
26546 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 26546
Metacarpal 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) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| 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 · 26546
Metacarpal 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 50 · payment effect
With and without the modifier
26546 without 50 · national facility
$993.34
Metacarpal repair
26546-50 · Bilateral: 150%
$1,490.01
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).
26546 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 26615Metacarpal fracture
- Use 26615 for open treatment of an acute metacarpal fracture. Use 26546 when the fracture has become an established nonunion or malunion requiring repair.
- 26600Metacarpal fracture care
- Code 26600 describes closed treatment without manipulation of an acute metacarpal fracture; 26546 addresses repair of an established nonunion or malunion.
- 26605Metacarpal fracture
- 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.
- 26565Metacarpal osteotomy
- Code 26565 is for corrective metacarpal osteotomy. Choose 26546 when the operative problem is an established metacarpal fracture nonunion or malunion.
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 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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