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See a sample rate comparisonCPT 26116 Fee Schedule
Last Verified: October 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.
Exc Hand Tum Deep 1 5 Cm, Excision Tumor Soft Tissue Or Vascular Malformation Of Hand Or Finger Subfascial Eg Intramuscular Less Than 1 5 Cm
| 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 |
| Medicare Fee Schedule | View Medicare rates for 26116 |
| Medicaid Fee Schedule | View Medicaid rates for 26116 |
National average reimbursement for CPT 26116 by major payers:
$704.22
$693.56
$743.30
$859.72
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CPT 26116
5 of 25 sample ratesHigher to lower in this preview
Surgcenter Of Greater Dallas, LLC., Surgcenter Of Greater Dallas
Surgcenter Of Greater Dallas LLC
$2,172.00Published rateEmerald Coast Surgery Center, Lp, Emerald Coast Surgery Center
Emerald Coast Surgery Center Lp
$1,261.21Published rateNorth Orange County Surgery Center
North Orange County Surgery Center, LLC
$755.00Published rateAdvanced Surgical Care Of Maryland, LLC
Advanced Surgical Care Of Maryland LLC
$568.00Published rateScac LLC, Surgery Center At Cranberry
Scac LLC
$480.00Published rate
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See a sample payer proposalCPT 26116 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 26116 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 26116 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 | Excision Tumor Or Vascular Ma, Excision Tumor Or Vascular Malformation Soft Tissue Of Hand Or Finger Subcutaneous 1.5 Cm Or Greater |
| 26113-CPT | Moderate | Exc Hand Tum Deep 1 5 Cm, Excision Tumor Soft Tissue Or Vascular Malformation Of Hand Or Finger Subfascial Eg Intramuscular 1 5 Cm Or Greater |
| 26115-CPT | Moderate | Xcision Tumor Or Vasculr Malform Sft Tissue Of Hand Or Finge, Excision Tumor Or Vascular Malformation Soft Tissue Of Hand Or Finge |
| 26116-CPT | Moderate | Exc Hand Tum Deep 1 5 Cm, 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 26116. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 26116 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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