Billing code 26645: Thumb fractureMedicare rate & RVUs in Washington
Reports closed treatment with manipulation of a fracture at the base of the thumb’s first metacarpal, such as a Bennett fracture.
Medicare pays $493.94–$553.86 for 26645 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 26645 covers
This code describes closed treatment of a fracture at the base of the first metacarpal, the bone connecting the thumb to the wrist, when the clinician manipulates the fracture to improve alignment. A Bennett fracture is a familiar example. An orthopedic surgeon or other qualified clinician may perform the reduction in an emergency department, hospital, or other treatment setting, then immobilize the thumb and wrist.
Choose the code based on the fracture’s location and the documented manipulation, rather than the use of a cast alone. The record should identify the first-metacarpal base fracture and support the reduction performed. The 90-day global period includes the day-before preoperative visit and related postoperative care during the following 90 days. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple procedure reduction. For bilateral reporting with modifier 50, CMS pays 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 26645 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | $493.94 | $397.22 |
| Seattle (King Cnty) | $553.86 | $441.16 |
How the 26645 rate is calculated
Each of 26645’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 · 26645
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 4.47Practice expense 9.05Malpractice 0.96
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 26645
26645 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 26645
Thumb fracture
| 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 · 26645
Thumb fracture
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
26645 without 50 · national office
$483.65
Thumb fracture
26645-50 · Bilateral: 150%
$725.48
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).
26645 compared with similar codes
Compare codes
26645 vs 26605 vs 26615 vs 26650 vs 26641: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 26605Metacarpal fracture
- Both involve manipulation of a metacarpal fracture, but 26645 is specific to a fracture at the base of the thumb’s first metacarpal.
- 26615Metacarpal fracture
- Use 26645 for closed manipulation; 26615 describes open treatment of a metacarpal fracture.
- 26650Thumb fracture-dislocation
- 26650 concerns a thumb phalanx fracture, while 26645 concerns the base of the first metacarpal.
- 26641Thumb dislocation
- 26641 is for a thumb carpometacarpal dislocation, not a fracture at the base of the first metacarpal.
26645 billing questions
When is this code appropriate instead of 26605?
Use 26645 for a fracture at the base of the first metacarpal treated with manipulation. Code 26605 describes manipulation of a metacarpal fracture in the broader metacarpal fracture group.
Does a cast or splint alone support this code?
No. The defining service includes manipulation of the thumb metacarpal base fracture. Document the reduction, not only the immobilization.
How does this differ from open or percutaneous fracture treatment?
This code is for closed treatment with manipulation. When the fracture is treated with open exposure or percutaneous skeletal fixation, select the code that describes that method.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care during the 90 days after surgery.
Can modifier 50 be used for fractures of both thumbs?
CMS lists this as a bilateral procedure; with modifier 50, payment is at 150%. The documentation should support treatment of both sides.
When is an assistant at surgery payable?
CMS payment for an assistant at surgery requires documentation of medical necessity. Co-surgeons and team surgery are not permitted for this code.
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
Fee sheets
Put 26645 and the rest of your codes on one sheet
Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.
Build my fee sheetOr price your code list free →