CPT 26113 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 | • 24 - Ambulatory Surgical Center • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • RT - Right side of body • LT - Left side of body |
| Complexity Level | Moderate |
National average reimbursement for CPT 26113 by major payers:
$731.74
$746.84
$772.17
$942.56
| 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 26113 | ||||||
United | 26113 | $835.00 | 1710985445 - HERSHEY ENDOSCOPY CENTER, LLC | 562336622 - (PA) HERSHEY ENDOSCOPY CENTER, LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26113 | $2353.00 | 1326142878 - LEBANON ENDOSCOPY CENTER LLC, LEBANON ENDOSCOPY CENTER | 205449574 - (TN) LEBANON ENDOSCOPY CENTER LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26113 | $1155.00 | 1215990627 - WESTSIDE SURGERY CENTER LLC, WESTSIDE SURGERY CENTER LTD | 593026856 - (FL) WESTSIDE SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26113 | $2388.00 | 1053574244 - SURGERY CENTER AT UNIVERSITY PARK, LLC, PREMIER SURGERY CENTER OF SARASOTA | 203757623 - (FL) SURGERY CENTER AT UNIVERSITY PARK LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26113 | $1235.00 | 1942265780 - SURGICARE OF WICHITA, LLC | 752198375 - (KS) SURGICARE OF WICHITA LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26113 | $956.84 | 1871889311 - NAVID BEHROOZ | 350593390 - DEACONESS HOSPITAL INC | VA | Emergency Medicine Physician (207P00000X) |
United | 26113 | $956.84 | 1518062819 - AZIZULLAH MEHRZAD | 350593390 - DEACONESS HOSPITAL INC | KY | Geriatric Medicine (Internal Medicine) Physician (207RG0300X) |
United | 26113 | $814.00 | 1659526457 - NORWOOD ENDOSCOPY CENTER, LLC | 263691316 - (OH) NORWOOD ENDOSCOPY CENTER, LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26113 | $1116.00 | 1619114824 - EAST COLUMBUS SURGERY CENTER LLC | 311641652 - (OH) EAST COLUMBUS SURGERY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26113 | $2307.00 | 1952814386 - ADVANCED SURGICAL CARE OF BOERNE, LLC | 821680961 - (TX) ADVANCED SURGICAL CARE OF BOERNE LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26113 | $1275.00 | 1770603706 - BIRMINGHAM AMBULATORY SURGICAL CENTER, PLLC, TRUVISTA SURGERY CENTER | 202208179 - (MI) BIRMINGHAM AMBULATORY SURGICAL | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26113 | $5177.00 | 1548844400 - SAINT LUKES SOUTH PAIN MANAGEMENT CENTER LLC | 863451115 - (KS) SAINT LUKES SOUTH PAIN MANAGEMENT CENTER LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26113 | $894.00 | 1255070116 - MERCY SOUTH ASC LLC, MERCY OUTPATIENT SURGERY CENTER - WEST BEND | 882512783 | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26113 | $1840.00 | 1689986879 - DEER POINTE SURGICAL CENTER, LLC, POA SURGERY CENTER | 272384315 - (MD) DEER POINTE SURGICAL CENTER, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26113 | $1725.00 | 1851356786 - WAUSAU SURGERY CENTER LLC | 621525773 - (WI) WAUSAU SURGERY CENTER, L.P. | WI | 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 26113 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 26113 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 26113 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 |
|---|---|---|
| 26111-CPT | Moderate | Ex Tum Vasc Malf Sft Tiss Hand Fngr Subq 1.5 Cm |
| 26113-CPT | Moderate | Excision, Tumor, Soft Tissue, Or Vascular Malformation, Of Hand Or Finger, Subfascial (Eg, Intramuscular); 1.5 Cm Or Greater |
| 26115-CPT | Moderate | Excision, Tumor Or Vascular Malformation, Soft Tissue Of Hand Or Finger, Subcutaneous; Less Than 1.5 Cm |
| 26116-CPT | Moderate | Excision, Tumor, Soft Tissue, Or Vascular Malformation, Of Hand Or Finger, Subfascial (Eg, Intramuscular); Less Than 1.5 Cm |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 26113. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 26113 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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