CPT 25526 Fee Schedule
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.
| Key Fact | Detail |
|---|---|
| Service Type | • Surgery • Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • RT - Right side of body • LT - Left side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 25526 |
National average reimbursement for CPT 25526 by major payers:
$1,255.03
$1,315.21
$1,340.12
$1,627.62
| 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 25526 | ||||||
United | 25526 | $3200.00 | 1952852873 - PACIFIC NORTHWEST UROLOGY SPECIALISTS, PLLC, PACIFIC NORTHWEST UROLOGY SURGERY CENTER | 473036836 - (WA) PACIFIC NORTHWEST UROLOGY SPECIALIST, PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25526 | $6087.00 | 1922510643 - OPTIMUM SPINE CENTER, LLC, PEACHTREE SPINE & PAIN PHYSICIANS | 320543789 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25526 | $4072.00 | 1801450986 - DOCTORS HOSPITAL, INC, BAPTIST HEALTH SURGERY CENTER CORAL GABLES | 43775926 - (FL) DOCTORS HOSPITAL INC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25526 | $875.00 | 1245201425 - ANDRE J GOLINO MD AND ASSOCIATES PA, PALM BEACH EYE CLINIC | 592348880 - (FL) ANDRE J GOLINO MD AND ASSOCIATES PA | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25526 | $3772.00 | 1063164960 - ADVANCED SURGICAL CARE OF VIERA, LLC | 872178964 - (FL) ADVANCED SURGICAL CARE OF VIERA LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25526 | $5302.00 | 1790066876 - CAROMONT HEALTH SERVICES, INC., CAROMONT ENDOSCOPY CENTER | 561455630 - (NC) CAROMONT HEALTH SERVICES INC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25526 | $1300.00 | 1629173075 - THE DIGESTIVE ENDOSCOPY CENTER OF MICHIGAN, PLLC, CROWNE POINT ENDOSCOPY & SURGERY CENTER | 352227535 - (MI) THE DIGESTIVE ENDOSCOPY CENTER OF MICHIGAN PLLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25526 | $5797.00 | 1255577045 - MAPLE LAWN SURGERY CENTER | 262739529 - (MD) MAPLE LAWN SURGERY CENTER, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25526 | $1185.00 | 1003036310 - MIDWEST ENDOSCOPY CENTER LLC | 208292570 - (IL) MIDWEST ENDOSCOPY CENTER LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25526 | $1229.00 | 1063905818 - INNOVATIVE EYE SURGERY CENTER, PLLC | 822843902 - (KY) INNOVATIVE EYE SURGERY CENTER PLLC | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25526 | $3573.00 | 1518004696 - CENTURY CITY ENDOSCOPY, LLC | 954754975 - (CA) CENTURY CITY ENDOSCOPY LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25526 | $3000.00 | 1700389822 - CENTER FOR SPINE INTERVENTIONS ASC 2 | 813634134 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25526 | $6365.00 | 1831420694 - TITUSVILLE CENTER FOR SURGICAL EXCELLENCE LLC | 263531997 - (FL) TITUSVILLE CENTER FOR SURGICAL | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25526 | $3489.00 | 1407812860 - THE SURGICAL CENTER OF THE TREASURE COAST, LLC | 371446353 - (FL) SURGICAL CENTER OF THE TREASURE COAST | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25526 | $6087.00 | 1306843222 - ST. JOSEPH'S OUTPATIENT SURGERY CENTER, LLC | 562332449 - (AZ) ST JOSEPHS OUTPATIENT SURGERY CENTER LLC | AZ | 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 25526 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 25526 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 25526 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 |
|---|---|---|
| 25520-CPT | Moderate | Closed Treatment Of Radial Shaft Fracture And Closed Treatment Of Dislocation Of Distal Radioulnar Joint (Galeazzi Fracture/Dislocation) |
| 25525-CPT | High | Open Treatment Of Radial Shaft Fracture, Includes Internal Fixation, When Performed, And Closed Treatment Of Distal Radioulnar Joint Dislocation (Galeazzi Fracture/ Dislocation), Includes Percutaneous Skeletal Fixation, When Performed |
| 25526-CPT | High | Open Treatment Of Radial Shaft Fracture, Includes Internal Fixation, When Performed, And Open Treatment Of Distal Radioulnar Joint Dislocation (Galeazzi Fracture/ Dislocation), Includes Internal Fixation, When Performed, Includes Repair Of Triangular Fibrocartilage |
| 25574-CPT | Moderate | Open Rad/Ulna Shaft Fix Rador Ulna |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 25526. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 25526 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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