Billing code 26992: Bone lesion drainageMedicare rate & RVUs in Utah
Reports operative drainage of a lesion within bone when the surgeon opens the affected site to evacuate its contents.
CMS doesn’t publish an office rate for 26992 in Utah.
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 26992 covers
This service involves surgically opening a bone lesion to drain its contents. An orthopedic surgeon or another surgeon treating bone disease typically performs it in an operating room or other surgical facility. The operative report should identify the bone and lesion treated, describe the approach and drainage performed, and distinguish the target from a nearby soft-tissue collection or bursa.
Report the code when the operative work is drainage of the bone lesion, rather than diagnostic bone sampling or removal of a tumor. CMS assigns a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included. 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 multiple-procedure reduction. Assistant-at-surgery payment requires documentation of medical necessity; 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.
26992 in Utah
| Payment locality | Office | Facility |
|---|---|---|
| Utah | Unavailable | $910.52 |
How the 26992 rate is calculated
Each of 26992’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 · 26992
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 13.14Practice expense 12.28Malpractice 2.87
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 26992
26992 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 26992
Bone lesion drainage
| 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) | 0 | Not paid without supporting documentation. |
| 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 · 26992
Bone lesion drainage
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
26992 without 51 · national facility
$944.91
Bone lesion drainage
26992-51 · Second procedure: 50%
$472.46
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%).
26992 compared with similar codes
Compare codes
26992 vs 26990 vs 26991 vs 20245: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 26990Abscess drainage
- Use 26992 for drainage of a lesion within bone. Code 26990 describes drainage directed to a pelvic lesion rather than a bone lesion.
- 26991Bursa drainage
- Code 26991 concerns drainage of a pelvic bursa. This code is for drainage of a lesion within bone.
- 20245Bone biopsy
- Code 20245 is for open bone biopsy to obtain diagnostic tissue. Use 26992 when the operative work is drainage of the bone lesion.
26992 billing questions
How is this different from a bone biopsy?
This code describes operative drainage of a bone lesion. A bone biopsy code is used when the service is obtaining tissue for diagnosis rather than draining the lesion.
What documentation supports reporting this code?
Document the bone and lesion treated, the operative approach, and the drainage performed. The note should make clear that the target was within bone, not a bursa or adjacent soft tissue.
Can an assistant surgeon be reported?
Assistant-at-surgery payment is allowed only when the record documents medical necessity. Co-surgeons and team surgery are not permitted for this code.
Does modifier 50 apply when lesions are treated on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code; modifier 50 should not be used.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
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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