CPT 25126 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 | • 22 - On Campus Outpatient Hospital • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • LT - Left side of body • RT - Right side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 25126 |
National average reimbursement for CPT 25126 by major payers:
$894.11
$850.42
$846.23
$1,045.20
| 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 25126 | ||||||
United | 25126 | $747.00 | 1033292214 - PIKES PEAK ENDOSCOPY AND SURGERY CENTER, LLC | 841379009 - (CO) PIKES PEAK ENDOSCOPY AND SURGERY CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25126 | $3500.00 | 1750363461 - BARKLEY SURGICENTER, LLC | 650428622 - (FL) BARKLEY SURGICENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25126 | $626.00 | 1538113238 - ADVANCED LASER & SURGICENTER OF ARIZONA, PC | 721546625 | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25126 | $3508.00 | 1225091739 - OUTPATIENT WOMEN'S AND CHILDREN'S SURGERY CENTER, LTD | 432016059 - (TX) OUTPATIENT WOMENS AND CHILDRENS SURGERY CENTER LTD | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25126 | $6904.00 | 1497312540 - MEMORIAL HERMANN SURGERY CENTER MAIN STREET, LLC | 384114079 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25126 | $2995.00 | 1255346045 - OMEGA SURGERY CENTER LLC | 470821405 - (NE) OMEGA SURGERY CENTER LLC | NE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25126 | $2689.00 | 1912678947 - ECCS ACQUISITION COMPANY LLC | 352656413 | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25126 | $2799.00 | 1881113785 - BANNER ESTRELLA SURGERY CENTER LLC | 901183954 | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25126 | $1648.00 | 1245340603 - MOUNTAIN EMPIRE CATARACT & EYE SURGERY CENTER | 30408358 - (TN) MOUNTAIN EMPIRE CATARACT EYE SURGERY CENTER | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25126 | $1512.00 | 1629032446 - AMBULATORY SURGERY CENTER GROUP LTD | 592073099 - (FL) AMBULATORY SURGERY CENTER GROUP LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25126 | $675.00 | 1780661967 - CJ ELMWOOD PARTNERS L P | 911793912 - CJ ELMWOOD PARTNERS L P | IA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25126 | $1387.00 | 1457335077 - DENVER EYE SURGERY CENTER, LLC | 840974806 - (CO) DENVER EYE SURGERY CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25126 | $3073.00 | 1255500781 - IOWA CITY AMBULATORY SURGICAL CENTER, LLC | 208503424 - (IA) IOWA CITY AMBULATORY SURGICAL CENTER | IA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25126 | $1150.00 | 1083898605 - MIDSOUTH INTERVENTIONAL PAIN INSTITUTE, LLC, MIDSOUTH PAIN TREATMENT CENTER, LLC | 261545635 - MIDSOUTH INTERVENTIONAL PAIN INSTITUTE LLC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25126 | $955.00 | 1467557678 - BEAN CENTER FOR FOOT SURGERY INC, SIERRA CENTER FOR FOOT SURGERY | 880309955 - (NV) BEAN CENTER FOR FOOT SURGERY INC | NV | 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 25126 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 25126 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 25126 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 |
|---|---|---|
| 25116-CPT | Moderate | Radical Excision Of Bursa, Synovia Of Wrist, Or Forearm Tendon Sheaths (Eg, Tenosynovitis, Fungus, Tbc, Or Other Granulomas, Rheumatoid Arthritis); Extensors, With Or Without Transposition Of Dorsal Retinaculum |
| 25125-CPT | Moderate | Excision Or Curettage Of Bone Cyst Or Benign Tumor Of Radius Or Ulna (Excluding Head Or Neck Of Radius And Olecranon Process); With Autograft (Includes Obtaining Graft) |
| 25126-CPT | Moderate | Excision Or Curettage Of Bone Cyst Or Benign Tumor Of Radius Or Ulna (Excluding Head Or Neck Of Radius And Olecranon Process); With Allograft |
| 25350-CPT | Moderate | Osteotomy Radius Distal Third |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 25126. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 25126 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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