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See a sample rate comparisonCPT 26011 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.
Drainage Finger Abscess;Complicated-Eg,F
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 21 - Inpatient Hospital 23 - Emergency Room |
| Common Modifiers | None F6 - Right hand, second digit F7 - Right hand, third digit |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 26011 |
| Medicaid Fee Schedule | View Medicaid rates for 26011 |
National average reimbursement for CPT 26011 by major payers:
$513.22
$554.38
$618.57
$725.91
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CPT 26011
5 of 25 sample ratesHigher to lower in this preview
Aurora Surgery Centers, LLC
Aurora Surgery Centers LLC
$3,024.00Published rateTexan Ambulatory Surgery Center, Texan Surgery Center
$1,528.00Published rateRads Of America, LLC, Premier Radiology Pain Management Center
Rads Of America LLC
$932.00Published rateAsc Development Company, LLC
Asc Development Company LLC
$565.00Published rateHouma Surgi-Center, Inc & Urology Clinic
Houma Surgi-Center & Urology Clinic (Amc)
$423.00Published rate
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See a sample payer proposalCPT 26011 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 26011 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 26011 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.
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 26011. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 26011 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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