CPT 26116 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 |
| Medicare Fee Schedule | View Medicare rates for 26116 |
National average reimbursement for CPT 26116 by major payers:
$704.22
$693.56
$743.30
$879.63
| 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 26116 | ||||||
United | 26116 | $743.00 | 1669414306 - FREEDOM VISION SURGERY CENTER LLC, FREEDOM VISION SURGERY CENTER LLC | 954673469 - (CA) FREEDOM VISION SURGERY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26116 | $532.00 | 1255390670 - CARROLL COUNTY EYE SURGERY CENTER, LLC | 50576667 - (MD) CARROLL COUNTY EYE SURGERY CENTER, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26116 | $489.00 | 1417985102 - SOUTHWESTERN EYE CENTER LTD, SOUTHWESTERN EYE CENTER | 860423068 - SOUTHWESTERN EYE CENTER, LTD. | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26116 | $545.00 | 1649515933 - NAPERVILLE FERTILITY CENTER, INC. | 204056909 | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26116 | $1700.00 | 1326144221 - FM ENDOSCOPY CENTER LLC, CENTER FOR SPECIAL SURGERY | 364810414 - (ND) FM ENDOSCOPY CENTER, LLC | ND | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26116 | $517.00 | 1710082680 - MBC AMBULATORY SURGERY CENTER, LP, MANN CATARACT SURGERY CENTER | 752841034 - (TX) MBC AMBULATORY SURGERY CENTER LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26116 | $480.00 | 1902876212 - SCAC LLC, SURGERY CENTER AT CRANBERRY | 562286973 - (PA) SCAC LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26116 | $758.00 | 1821421256 - MONOCACY SURGERY CENTER LLC | 462861862 - (MD) MONOCACY SURGERY CENTER | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26116 | $568.00 | 1679149330 - ADVANCED SURGICAL CARE OF MARYLAND, LLC | 861991275 - (MD) ADVANCED SURGICAL CARE OF MARYLAND LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26116 | $2172.00 | 1245798826 - SURGCENTER OF GREATER DALLAS, LLC., SURGCENTER OF GREATER DALLAS | 831498677 - (TX) SURGCENTER OF GREATER DALLAS LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26116 | $1276.00 | 1295479780 - ADVENTHEALTH SURGERY CENTER DAVENPORT LLC | 881811228 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26116 | $931.00 | 1851407373 - RIVERSIDE AMBULATORY SURGERY CENTER, LLC | 320082320 - (IL) RIVERSIDE AMBULATORY SURGERY CENTER, LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26116 | $1261.21 | 1437114378 - EMERALD COAST SURGERY CENTER, LP, EMERALD COAST SURGERY CENTER | 621502718 - (FL) EMERALD COAST SURGERY CENTER LP | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26116 | $1231.00 | 1063453561 - TEMPLETON SURGERY CENTER, LLC, TEMPLETON SURGERY CENTER | 202246616 - (CA) TEMPLETON SURGERY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26116 | $1258.00 | 1740328947 - ENDOSCOPY CONSULTANTS, LLC | 510425612 - (GA) ENDOSCOPY CONSULTANTS LLC | GA | 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 |
Want to see your competitors' rates?
Start your trial today to unlock complete access to provider rates and fee schedules in your area.
Here's what you can do with PayerPrice
Renegotiate your managed care contracts
Benchmark your current rates against market averages to identify opportunities for rate optimization.
Prospect for new business using fee schedules
Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.
Integrate real-time payer data into your workflows
Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.
PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.
CPT 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 | 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 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.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 26116) and we'll show you how you compare in 15 minutes or less.