Billing code 26641: Thumb dislocationMedicare rate & RVUs in Washington
Reports closed manipulation of a dislocated thumb carpometacarpal joint when reduction is performed under anesthesia and no fracture-dislocation is treated.
Medicare pays $480.38–$540.21 for 26641 in the office in Washington, from Rest Of Washington to Seattle (King Cnty). Which amount applies depends on the service address.
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 26641 covers
This service treats a dislocation at the base of the thumb, where the first metacarpal meets the wrist bones. The physician, commonly an orthopedic or hand surgeon, manipulates the joint back into position under anesthesia without open surgical exposure. It may be performed in an operating room or another setting equipped to provide the required anesthesia and manage the reduction.
Report the code for an isolated thumb carpometacarpal dislocation treated by closed manipulation under anesthesia, not for a fracture-dislocation or an open procedure. Documentation should identify the joint and side, establish the dislocation, and describe the reduction and anesthesia. 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. Bilateral reporting with modifier 50 is paid at 150%. 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.
Where 26641 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | $480.38 | $390.70 |
| Seattle (King Cnty) | $540.21 | $435.70 |
How the 26641 rate is calculated
Each of 26641’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 · 26641
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 4.03Practice expense 9.16Malpractice 0.86
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 26641
26641 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 26641
Thumb 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) | 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 · 26641
Thumb 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
26641 without 50 · national office
$469.28
Thumb dislocation
26641-50 · Bilateral: 150%
$703.92
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).
26641 compared with similar codes
Compare codes
26641 vs 26645 vs 26670 vs 26685: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 26645Thumb fracture
- Use 26641 for an isolated thumb carpometacarpal dislocation. Use 26645 when the thumb injury is a fracture-dislocation.
- 26670Hand dislocation
- This code addresses a thumb carpometacarpal dislocation; 26670 is for a carpometacarpal dislocation at another hand site.
- 26685Hand dislocation
- This code describes closed manipulation of a thumb joint dislocation under anesthesia. Code 26685 is for open treatment of a non-thumb carpometacarpal dislocation.
26641 billing questions
How does this differ from code 26645?
This code is for an isolated thumb carpometacarpal dislocation. Code 26645 is for a thumb carpometacarpal fracture-dislocation, where a fracture accompanies the dislocation.
Can routine follow-up be billed separately?
Related postoperative care during the 90-day global period is included, along with the day-before preoperative visit.
How is bilateral treatment reported?
Use modifier 50 for bilateral treatment; CMS pays the bilateral procedure at 150%.
When may an assistant-at-surgery be paid?
Payment is allowed only when the record documents medical necessity. Co-surgeons and team surgery are not permitted for this code.
What happens when another procedure is performed in the same session?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and the other procedure or procedures are paid at 50%.
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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