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See a sample rate comparisonCPT 21026 Fee Schedule
Last Verified: September 2026
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.
Xcision Of Bone (Eg For Osteomyeli Or Bone Absces); Facial Bone, Excision Of Bone (Eg For Osteomyelitis Or Bone Abscess); Facial Bone(
| 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 |
| Medicaid Fee Schedule | View Medicaid rates for 21026 |
National average reimbursement for CPT 21026 by major payers:
$677.99
$758.57
$767.92
$903.74
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CPT 21026
5 of 25 sample ratesHigher to lower in this preview
Pinnacle Surgery Center, Inc
Pinnacle Surgery Center Inc
$8,000.00Published rateDestin Surgery Center LLC
$2,206.00Published rateSeattle Pain Relief PLLC, Federal Way Ambulatory Surgical Facility
Seattle Pain Relief PLLC
$1,525.00Published rateValley Outpatient Surgical Center Inc
$1,091.00Published rateUnion City Asc LLC, Summit Endoscopy Center
$800.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 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 | Xcision Of Bone (Eg For Osteomyeli Or Bone Absces); Mandibl, Excision Of Bone (Eg For Osteomyelitis Or Bone Abscess); Mandible |
| 21026-CPT | Moderate | Xcision Of Bone (Eg For Osteomyeli Or Bone Absces); Facial Bone, Excision Of Bone (Eg For Osteomyelitis Or Bone Abscess); Facial Bone( |
| 21029-CPT | Moderate | Remval By Contour Of Bnign Tumor Of Facial Bone (Eg Fibrous Dysp, Removal By Contouring Of Benign Tumor Of Facial Bone (Eg Fibrous Dysp |
| 21040-CPT | Moderate | Excision Of Benign Cyst Or Tum, Excision Of Benign Cyst Or Tumor Of Mandible Simpleexcision Of Benign Cyst Or Tumor Of Mandible Simple |
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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