CPT 26117 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 • LT - Left side of body • RT - Right side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 26117 |
National average reimbursement for CPT 26117 by major payers:
$950.42
$974.31
$1,029.02
$1,233.49
| 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 26117 | ||||||
United | 26117 | $941.00 | 1750456539 - WIREGRASS RANCH ASC HOLDINGS, WIREGRASS RANCH AMBULATORY SURGERY CENTER | 991010158 - (FL) WIREGRASS RANCH ASC HOLDINGS | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26117 | $1179.00 | 1750499950 - MEDPLEX OUTPATIENT SURGERY CENTER LTD, MEDPLEX OUTPATIENT SURGERY CENTER | 760353620 - (AL) MEDPLEX OUTPATIENT SURGERY CENTER LTD | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26117 | $600.00 | 1386632610 - LHZ LIMITED PTR, SAINT CLARE SURGERY CENTER | 341816442 - (OH) LHZ LIMITED PTR | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26117 | $410.00 | 1487122669 - CONWAY CARDIOVASCULAR SURGERY CENTER, LLC | 832435695 - (AR) CONWAY CARDIOVASCULAR SURGERY CENTER LLC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26117 | $758.00 | 1356704027 - GLEN ECHO SURGERY CENTER, LLC | 474049838 - (MD) GLEN ECHO SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26117 | $1276.00 | 1861905176 - BERKSHIRE EYE, LLC | 352609003 | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26117 | $641.00 | 1164419842 - MONTGOMERY SURGERY CENTER LLC. | 233078434 - (PA) MONTGOMERY SURGERY CENTER LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26117 | $735.00 | 1083384432 - NASHVILLE SURGICENTER, LLC | 474086590 - (TN) NASHVILLE SURGICENTER LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26117 | $1179.00 | 1366935074 - SKYWAY SURGERY CENTER, LLC | 813237016 - (FL) SKYWAY SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26117 | $1000.00 | 1356080642 - LEGENT OUTPATIENT SURGERY SINGING HILLS, LLC, LEGENT OUTPATIENT SURGERY SINGING HILLS | 861677359 - (TX) LEGENT OUTPATIENT SURGERY SINGING HILLS LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26117 | $600.00 | 1588797807 - SPOKANE DIGESTIVE DISEASE CENTER, P.S., SOUTH ASC | 911013238 - (WA) SPOKANE DIGESTIVE DISEASE CENTER P.S. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26117 | $1276.00 | 1588854772 - ALABAMA DIGESTIVE HEALTH ENDOSCOPY CENTER, LLC | 201243484 - (AL) ALABAMA DIGESTIVE HEALTH | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26117 | $1039.00 | 1831484567 - GRIFFISS EC, LLC, GRIFFISS EYE SURGERY CENTER | 263738675 - (NY) GRIFFISS EC LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26117 | $680.00 | 1225042575 - PACIFIC SURGERY CENTER LLC | 931265552 - PACIFIC SURGERY CENTER, LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26117 | $607.00 | 1437642857 - GEORGIA VASCULAR & VEIN CENTER | 822239594 - (GA) GEORGIA VASCULAR VEIN CENTER | 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 |
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CPT 26117 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 26117 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 26117 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 |
| 26117-CPT | Moderate | Radical Resection Of Tumor (Eg Sarcoma) Soft Tissue Of Hand Or Finger; Less Than 3 Cm (Revised 01/01/2014) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 26117. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 26117 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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