$224.29
Use 26720 when a proximal or middle phalanx shaft fracture is treated without manipulation. This code requires manipulation.
On this page
CMS RVU26D · Effective 2026-10-01
26725 Finger fracture treatment Medicare reimbursement rates in Utah
Closed treatment of a proximal or middle phalanx shaft fracture with manipulation, reported for each finger or thumb fracture treated. Compare 26725 office and facility rates across CMS payment localities in Utah.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 26725 in Utah?
Utah has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$377.84
1 of 1 localities have a supported rate.
Payment area: Utah
One mapped payment locality.
Facility setting
$308.45
1 of 1 localities have a supported rate.
Payment area: Utah
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Orthopedic fracture care
About 26725: Closed reduction of finger phalanx shaft fracture
Closed treatment of a proximal or middle phalanx shaft fracture with manipulation, reported for each finger or thumb fracture treated.
This service is for a shaft fracture of the proximal or middle phalanx of a finger or thumb when the clinician manipulates the fracture to improve alignment without surgically exposing it. An orthopedic or hand surgeon commonly performs the reduction in an office, emergency department, or operating room, then immobilizes the digit with an appropriate splint or cast. The code is reported for each fracture treated.
Documentation should identify the digit and phalanx, establish that the fracture involves the shaft, and support the need for and performance of manipulation. This code has a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. 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 is inappropriate. Medicare does not pay an assistant at surgery for this service, and co-surgeons and team surgery are not permitted.
CMS billing rules for 26725
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU3.39 · 29%
- Practice expense (office) RVU7.74 · 65%
- Malpractice RVU0.72 · 6%
2K
Medicare services in 2024 · #2472 by national volume
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.
26725 compared with similar codes
Office rates for Utah, from the same CMS release.
No office rate
26727 includes skeletal traction with manipulation for a proximal or middle phalanx shaft fracture; this code describes manipulation without that traction.
No office rate
26735 is for open treatment of a proximal or middle phalanx shaft fracture. This code is for closed treatment with manipulation.
$249.97
26740 concerns a fracture involving a metacarpophalangeal or interphalangeal joint. This code is for a proximal or middle phalanx shaft fracture.
Compare 26725 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Utah →
Office / nonfacility
$377.84
Facility
$308.45
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 26725 in Utah.
PPRRVU2026_Oct_nonQPP.csv
2,677
- Code
- 26725
- Physician work
- 3.39
- Practice expense
- 7.74
- Malpractice
- 0.72
GPCI2026.csv
104
- Locality
- Utah
- Physician work
- 1.000
- Practice expense
- 0.940
- Malpractice
- 0.898
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.39 | × 1.000 | 3.3900 |
| Practice expense | 7.74 | × 0.940 | 7.2756 |
| Malpractice | 0.72 | × 0.898 | 0.6466 |
| Total RVUs | 11.3122 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Utah$377.84
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.39 | 1 |
| Practice expense | 7.74 | 0.94 |
| Malpractice | 0.72 | 0.898 |
(3.39 × 1 + 7.74 × 0.94 + 0.72 × 0.898) × $33.4009 = $377.84
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.39 | 1 |
| Practice expense | 5.53 | 0.94 |
| Malpractice | 0.72 | 0.898 |
(3.39 × 1 + 5.53 × 0.94 + 0.72 × 0.898) × $33.4009 = $308.45
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
26725 billing questions
How does this differ from 26720?
26725 is for a proximal or middle phalanx shaft fracture that is manipulated to improve alignment. Use 26720 when the fracture is treated without manipulation.
When would 26727 be more appropriate?
26727 describes treatment of this shaft-fracture type with manipulation and skeletal traction. This code covers manipulation without that traction method.
Can the reduction and splinting be billed as separate fracture services?
The manipulation and immediate immobilization are part of the closed fracture treatment. Do not report the same treatment as an open or percutaneous fixation procedure.
Should modifier 50 be used for fractures on both hands?
No. CMS identifies bilateral adjustment as inappropriate for this code. Report the service for each fracture treated, following applicable claim-edit instructions.
What documentation supports reporting this code?
Document the affected digit and phalanx, the shaft-fracture location, the manipulation performed, and the resulting treatment plan or immobilization.
Can an assistant surgeon or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this service. 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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
2,67426706,,Pin knuckle dislocation,A,,5.18,6.45,NA,6.45,,0.89,12.52,12.52,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,67526715,,Treat knuckle dislocation,A,,6.85,8.15,NA,8.15,,1.32,16.32,16.32,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,67626720,,Treat finger fracture each,A,,1.72,4.97,,4.06,,0.36,7.05,6.14,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,67726725,,Treat finger fracture each,A,,3.39,7.74,,5.53,,0.72,11.85,9.64,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,67826727,,Treat finger fracture each,A,,5.28,7.36,NA,7.36,,1.04,13.68,13.68,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,67926735,,Treat finger fracture each,A,,7.23,8.27,NA,8.27,,1.40,16.90,16.90,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,68026740,,Treat finger fracture each,A,,2.02,5.44,,4.36,,0.39,7.85,6.77,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
10104412,TX,15,GALVESTON,1.008,0.993,0.828
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985