CPT 21026 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Surgery • Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | • 11 - Office • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • 59 - Distinct Procedural Service • 58 - Staged or related procedure during postoperative period |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 21026 |
National average reimbursement for CPT 21026 by major payers:
$677.99
$758.57
$767.92
$935.80
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 21026 | ||||||
United | 21026 | $1129.00 | 1134687981 - ARMENIA AMBULATORY SURGICAL CENTER, LLC | 833888664 - (FL) ARMENIA AMBULATORY SURGICAL CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21026 | $5048.00 | 1679065759 - MEMORIAL HERMANN SURGERY CENTER BRAZORIA, LLC | 830759140 - (TX) MEMORIAL HERMANN SURGERY CENTER BRAZORIA LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21026 | $1547.00 | 1902960206 - SINUS SURGERY CENTER IDAHO PA | 205282962 - (ID) SINUS SURGERY CENTER IDAHO PA | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21026 | $1525.00 | 1902447386 - SEATTLE PAIN RELIEF PLLC, FEDERAL WAY AMBULATORY SURGICAL FACILITY | 455527273 - (WA) SEATTLE PAIN RELIEF PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21026 | $1091.00 | 1104894369 - VALLEY OUTPATIENT SURGICAL CENTER INC | 860585124 - (AZ) VALLEY OUTPATIENT SURGICAL CENTER INC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21026 | $936.00 | 1255872784 - MIDATLANTIC ENDOSCOPY LLC, MID-ATLANTIC GASTROINTESTINAL CENTER | 814079161 | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21026 | $1786.00 | 1023001377 - SOUTHERN ILLINOIS ORTHOPEDIC CENTER,LLC | 371377370 - (IL) SOUTHERN ILLINOIS ORTHOPEDIC CENTERLLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21026 | $800.00 | 1972549491 - UNION CITY ASC LLC, SUMMIT ENDOSCOPY CENTER | 621625423 | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21026 | $2206.00 | 1871594275 - DESTIN SURGERY CENTER LLC | 593723179 - (FL) DESTIN SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21026 | $1050.00 | 1083206866 - FIANNA HILLS SURGERY CENTER INC | 845048943 - (AR) FIANNA HILLS SURGERY CENTER INC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21026 | $1821.00 | 1215531215 - HAUPPAUGE SC, LLC | 352651325 - (NY) HAUPPAUGE SC LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21026 | $3624.00 | 1346403854 - THE EMORY CLINIC INC, EMORY ORTHOPAEDIC SURGERY CENTER | 464115055 - (GA) EMORY AMBULATORY SURGERY CENTER AT DUNWOODY LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21026 | $7169.00 | 1174969372 - AURORA GI ASC LLC, WISCONSIN DIGESTIVE HEALTH CENTER | 461848055 - (WI) AURORA GI ASC LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21026 | $1350.00 | 1184689408 - EVERGREEN EYE CENTER, PLLC, EYE ASSOCIATES NORTHWEST SURGERY CENTER | 911610832 - (WA) EYE ASSOCIATES NORTHWEST, PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 21026 | $2100.00 | 1124068549 - CROWN VALLEY SURGERY CENTER | 454125214 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 21026 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 21026 code is part of the Surgery services used for Surgical Procedures on the Musculoskeletal System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 21026 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 21025-CPT | High | Excision Mandible |
| 21026-CPT | Moderate | Exc Bone Facial Bones Osteomyelitis/A |
| 21029-CPT | Moderate | Removal By Contouring Of Benign Tumor Of Facial Bone -Commercial Rn Review=8/1/2001-5/31/2022: Medicaid Rn Review=8/1/2001-9/30/2020 |
| 21032-CPT | Moderate | Excision Maxillary Torus Palatinus |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 21026. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 21026 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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