CPT Code 26055 Explained: Procedures, Modifiers, and Reimbursement

In 2025, precise medical coding remains central to accurate claim submission and reimbursement, especially for surgical procedures like trigger finger release. Among the most frequently used musculoskeletal codes, CPT code 26055 defines a common yet critical operation that restores hand mobility and relieves pain caused by stenosing tenosynovitis.  

For coders, billers, and healthcare providers, mastering the nuances of the 26055 CPT code description, documentation requirements, and modifiers ensures compliance, prevents denials, and optimizes revenue integrity. 

This comprehensive guide explains CPT 26055 in detail, covering procedure steps, anatomical relevance, correct modifier usage, payer updates, and reimbursement trends.

Whether you’re coding for a right trigger thumb release CPT code or a left trigger thumb release CPT code, understanding the specifics of CPT trigger finger release helps you submit accurate, compliant claims every time. 

What Is CPT Code 26055? 

The official 26055 CPT code description, as defined by the American Medical Association (AMA), is: 

“Tendon sheath incision (e.g., for trigger finger).” 

This procedure is most often associated with the surgical treatment of stenosing tenosynovitis, commonly called “trigger finger.” The condition occurs when the flexor tendon becomes inflamed and gets caught in the pulley system of the finger, leading to pain, locking, or stiffness. 

Because of its prevalence in orthopedics and hand surgery, CPT 26055 is a high-volume procedure code. According to CMS outpatient utilization data, tens of thousands of claims are submitted annually under this code. 

Also Read: Pain Management CPT Codes Sheet

When to Use CPT Code 26055 

Use CPT code 26055 when the physician performs a surgical release of a tendon sheath to treat trigger finger or trigger thumb. It is not to be confused with tendon repairs, tenolysis (26010–26020), or complex hand surgeries involving multiple tendons. 

It should not be used for: 

• Non-surgical interventions like steroid injections or splinting. 
• Endoscopic approaches (these may require different reporting). 
• Procedures outside the scope of the tendon sheath incision. 

In practice, a claim with trigger finger CPT should be backed by operative documentation showing the incision into the tendon sheath. If the operative note does not match the surgical definition, the claim risks denial. 

Procedure Overview: What Happens During CPT 26055 

The CPT trigger finger release procedure typically involves: 

1. Local anesthesia is administered to numb the affected area. 
2. A small incision (usually less than 2 cm) is made near the A1 pulley. 
3. The surgeon identifies and carefully divides the constricted sheath around the flexor tendon. 
4. The tendon is tested for smooth gliding. 
5. The incision is closed with sutures, and a sterile dressing is applied. 

This operation takes about 15–30 minutes and can often be performed in an outpatient or ambulatory surgical setting. 

Right and Left Trigger Thumb Specificity 

While CPT code 26055 itself does not distinguish between laterality, payers increasingly require laterality documentation. That’s where ICD-10 codes come in.  

For example: 

• Right trigger thumb release CPT code would be paired with ICD-10 M65.311 (Trigger thumb, right hand). 
• Left trigger thumb release CPT code would be paired with ICD-10 M65.312 (Trigger thumb, left hand). 

Accurate linkage between CPT 26055 and the corresponding ICD-10 ensures medical necessity is established for the correct side of the body. 

Appropriate Modifiers for CPT 26055 

Modifiers help add clarity to claims involving 26055. The most common include: 

• Modifier 50 (bilateral procedure): If the surgeon releases trigger finger on both hands in the same session. 
• Modifier 59 (distinct procedural service): When another unrelated procedure is performed during the same encounter. 
• Modifier LT/RT: Used by some payers for specifying the left or right site, especially for right trigger thumb release CPT code or left trigger thumb release CPT code. 

However, applying modifiers incorrectly is one of the top denial reasons for the 26055 CPT code. For example, reporting modifier 50 when the release is done on two fingers of the same hand (not bilateral) would be flagged as incorrect. 

Reimbursement and Payer Guidelines 

Medicare assigns CPT 26055 a global surgical period of 90 days, meaning follow-up care related to the surgery is bundled into the payment. 

National Medicare reimbursement rates for 26055 in 2024 averaged: 

• Facility setting: around $500–$650 
• Non-facility setting (office): around $800–$1,000 

Commercial payer rates vary but generally align within these ranges. It’s essential to confirm payer-specific rules, as some require prior authorization for trigger finger release procedures. 

From a revenue cycle perspective, coding 26055 correctly and ensuring proper modifier and ICD-10 linkage can prevent costly denials. According to HFMA, improper musculoskeletal coding accounts for up to 15% of denied orthopedic claims. 

Common Coding Errors with CPT 26055 

Even experienced coders encounter pitfalls with CPT 26055. Common issues include: 

Incorrectly using injection codes instead of surgical release

Providers sometimes mistakenly bill 20550 (injection into tendon sheath) instead of 26055 for true surgical release. This error not only reduces reimbursement but also risks compliance violations. 

Failing to document laterality

When operative notes omit whether the release was on the right or left thumb, the claim may be denied for lack of specificity, particularly when using ICD-10 coding for trigger finger release CPT code. 

Improper use of modifiers

Misuse of modifier 50 for multiple releases on the same hand often triggers payer denials or audits. 

Must Read: Chiropractic Modifiers 2025

Compliance Considerations 

Because musculoskeletal procedures are frequently audited, coding 26055 requires strict adherence to documentation standards.  

Best practices include: 

• Ensuring operative notes clearly describe the tendon sheath incision. 

• Linking 26055 to the correct ICD-10 laterality code. 

• Applying modifiers only when documentation supports their use. 

CMS and commercial payers closely monitor CPT trigger finger release billing patterns. Overuse, duplicate billing, or a lack of documentation can expose providers to audits. 

Practical Example: Avoiding Denials 

Consider a hand surgery practice that reported 26055 for a patient with trigger finger but omitted laterality in the ICD-10 diagnosis. The claim was denied for lack of medical necessity. After correcting the documentation and linking the claim to M65.312 (left trigger thumb), the reimbursement was successfully recovered. 

This example highlights why accuracy at both the coding and documentation levels is essential. 

Best Practices Checklist for CPT 26055 

• Always confirm that the operative documentation specifies a tendon sheath incision. 
• Link ICD-10 diagnosis codes with correct laterality. 
• Use modifiers (50, 59, LT, RT) only when documentation supports it. 
• Review payer-specific policies for trigger finger CPT procedures. 
• Audit coding patterns regularly to detect recurring errors. 

AffinityCore: Your Partner in Accurate Surgical Coding 

At AffinityCore, we specialize in precision-driven medical billing and coding solutions that help healthcare providers navigate complex procedural codes like CPT 26055 with ease. Our certified coders and compliance experts ensure every 26055 CPT code submission aligns with the latest AMA CPT trigger finger release guidelines and payer rules. 

We support practices by: 

• Providing real-time coding audits and 26055 CPT code description validation.
• Assisting with modifier application for right trigger thumb release CPT code and left trigger thumb release CPT code.
• Streamlining denials related to trigger finger release CPT code documentation.
• Monitoring payer policy updates for 2025 reimbursement trends.

With AffinityCore’s expertise, your team can eliminate guesswork, reduce denials, and capture every dollar earned through compliant, optimized coding practices. 

Wrapping it Up! 

CPT code 26055 plays a central role in musculoskeletal surgery billing, particularly for trigger finger release procedures. Accurate coding requires more than knowing the description; it demands proper documentation, correct modifier use, and payer-specific compliance. 

For providers and revenue cycle teams, understanding 26055 thoroughly not only safeguards reimbursement but also strengthens compliance. Partnering with experts like AffinityCore ensures these processes are managed with precision. 

-Need support with accurate coding and denial prevention?  

AffinityCore’s medical billing and RCM experts are here to help. Let’s Not Wait and Contact Us Now! 

FAQs  

Q1. What is CPT code 26055 used for?

Ans. CPT 26055 represents a tendon sheath incision, commonly known as a trigger finger release CPT code. 

Q2. Can CPT code 26055 be used for the thumb?

Ans. Yes, right trigger thumb release CPT code and left trigger thumb release CPT code both fall under CPT 26055 when performed surgically. 

Q3. What modifier should be used for bilateral trigger finger release?

Ans. Use Modifier 50 for bilateral procedures when both hands or thumbs are treated during the same session. 

Q4. What diagnosis code pairs with CPT 26055?

Ans. Use ICD-10 codes M65.30–M65.379 for stenosing tenosynovitis (trigger finger). 

Q5. What is the global period for CPT 26055?

Ans. The global period for CPT 26055 is typically 90 days, meaning related postoperative care is included. 

Q6. Can 26055 be billed multiple times?

Ans. Yes, when multiple digits are treated, report 26055 for each and append appropriate modifiers (-59, -LT, -RT). 

Q7. What is the reimbursement rate for CPT 26055 in 2025?

Ans. The average Medicare payment ranges between $250–$600, depending on the setting and payer. 

Q8. What documentation is required for CPT 26055?

Ans. Operative notes should include the digit treated, laterality, technique, and diagnosis of stenosing tenosynovitis. 

Q9. Can CPT 26055 be performed endoscopically?

Ans. Yes. Even with a percutaneous approach, CPT 26055 applies unless a separate code is introduced. 

Q10. Why is CPT 26055 sometimes denied?

Ans. Denials often occur due to missing modifiers, incomplete documentation, or incorrect diagnosis linkage.