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See a sample rate comparisonCPT 25426 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
Repr.Defect W/Autogft;Radius & Ulna
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 21 - Inpatient Hospital 24 - Ambulatory Surgical Center 22 - On Campus Outpatient Hospital |
| Common Modifiers | None LT - Left side of body AG - Primary physician RT - Right side of body 58 - Staged or related procedure during postoperative period |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 25426 |
| Medicaid Fee Schedule | View Medicaid rates for 25426 |
National average reimbursement for CPT 25426 by major payers:
$1,552.70
$1,551.22
$1,533.57
$1,857.35
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CPT 25426
5 of 25 sample ratesHigher to lower in this preview
Medplex Outpatient Surgery Center Ltd, Medplex Outpatient Surgery Center
Medplex Outpatient Surgery Center Ltd
$5,020.00Published rateIronbound Endo Surgical Center, Inc.
$3,100.00Published rateLakeland Surgical & Diagnostic Center LLP
$2,142.00Published rateUnion Surgery Center, Inc, Advanced Endoscopy Center
Union Surgery Center Inc
$1,715.00Published rateDigestive Health Complex
$645.00Published rate
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See a sample payer proposalCPT 25426 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 25426 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 25426 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 |
|---|---|---|
| 25365-CPT | High | Surgery To Align Arm Bone, Surgery To Cut One Or More Bones In The Lower Arm (Radius Or Ulna). This Procedure Is Usually Done To Correct Positioning Of A Previously Broken Bone. |
| 25375-CPT | High | Multiple Osteotomies With Rea, Multiple Osteotomies With Realignment On Intramedullary Rod(Sofield Type Procedure) Radius And Ulna |
| 25420-CPT | High | Repair Poorly Healed Arm Bone, Surgery To Repair One Or Both Bones In The Lower Arm That Has Failed To Heal Completely Or That Healed In The Wrong Position After A Break. |
| 25426-CPT | High | Repr.Defect W/Autogft;Radius & Ulna |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 25426. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 25426 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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