CPT 26862, in plain terms, covers Surgeon fuses a single interphalangeal joint of a finger or thumb using bone graft taken from the patient, with internal fixation if needed. CPT 26862 is referenced in 7 tracked payer policy changes from UnitedHealthcare, Regence BlueShield, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 26862 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Official descriptor: CPT 26862 on AAPC
UnitedHealthcare is removing a long list of CPT codes from the applicable-code list of its Outpatient Surgical Procedures site-of-service policy for Exchange plans, and it is also removing the link to the Manipulation Under Anesthesia policy. The change takes effect December 1, 2026. The source does not state a new billing requirement for the removed codes.
Effective December 1, 2026, UMR removes more than 500 CPT codes from its Outpatient Surgical Procedures - Site of Service medical policy for commercial plans, and it drops a reference link to the Manipulation Under Anesthesia policy. For those codes, UMR's site-of-service policy no longer applies, so the practice should update its internal UMR site-of-service and prior authorization lists before that date.
Effective December 1, 2026, UnitedHealthcare removes more than 500 CPT codes from its Outpatient Surgical Procedures - Site of Service medical policy for commercial plans, and it drops a reference link to the Manipulation Under Anesthesia policy. For those codes, the site-of-service policy no longer applies under this UnitedHealthcare commercial policy, so the practice should update its internal site-of-service and prior authorization lists before that date.
Effective November 1, 2026, site of care medical necessity reviews apply to the listed surgical procedures only when they are performed in an outpatient hospital setting. Use of a hospital outpatient department instead of an ambulatory surgery center or physician office may be considered medically necessary when one or more listed criteria are met, such as no geographically accessible in-network ASC that has the necessary equipment, a procedure that requires discontinuing medications that necessitate inpatient monitoring or treatment, ASA Physical Status III or higher, or a BMI over 40. Hospital outpatient use is considered not medically necessary when the criteria are not met.
This surgical site of care policy sets criteria for when a hospital outpatient department may be considered medically necessary instead of an ambulatory surgery center or physician office for listed surgical procedures. Hospital outpatient use may be considered medically necessary when one or more criteria are met, such as no qualifying in-network ASC within 25 miles that can provide the necessary care, an ASA Physical Status Classification of III or higher, a body mass index over 40, or a surgery expected to last longer than 3 hours. Use of a hospital outpatient department instead of an ASC or physician office is considered not medically necessary when the criteria are not met. The procedure may require prior authorization separately under its own medical policy.
Aetna considers MCP and PIP joint implants medically necessary for members with symptomatic rheumatoid arthritis, systemic lupus erythematosus, osteoarthritis, or post-traumatic arthritis when conservative medical management fails to relieve pain or digit deformity interferes with hand function and activities of daily living. The listed implants are Ascension MCP and Integra PyroCarbon MCP implants when soft tissue reconstruction can provide adequate stabilization, Ascension PIP and Avanta MCP and PIP implants when soft tissue and bone can provide adequate stabilization and fixation, and silicone-elastomer MCP and PIP total joint implants. Aetna considers the other MCP and PIP implant indications, DIP joint implants and splints, CMC and TMC joint implants, CapFlex-PIP, Tactys, Silktoe, PIP resurfacing arthroplasty, and X-Fuse for DIP joint arthrodesis experimental, investigational, or unproven.
Aetna reviewed its clinical policy bulletin on finger and thumb joint implants (CPB 0798) on 10/30/2026. The bulletin says Aetna covers certain MCP and PIP joint implants for symptomatic rheumatoid arthritis, lupus, osteoarthritis or post-traumatic arthritis when conservative care has failed, and it calls DIP, CMC/TMC, CapFlex-PIP, Tactys, X-Fuse, Duafit, Silktoe and PIP resurfacing implants experimental, investigational or unproven. The source does not say what changed from the prior version and gives no new effective date.
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