CPT 26121 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 26121 |
National average reimbursement for CPT 26121 by major payers:
$787.17
$807.03
$845.69
$1,017.41
| 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 26121 | ||||||
United | 26121 | $1043.64 | 1841570140 - PRASONGCHAI SATTAYAPRASERT | 350593390 - DEACONESS HOSPITAL INC | IN | Clinical Cardiac Electrophysiology Physician (207RC0001X) |
United | 26121 | $1750.00 | 1265859573 - MODESTO SPECIALTY SURGERY CENTER, PC | 454954897 - (CA) MODESTO SPECIALTY SURGERY CENTER PC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26121 | $1202.00 | 1073593109 - MARYVILLE ASC, TENNESSEE ENDOSCOPY CENTER | 621587667 - (TN) MARYVILLE ASC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26121 | $2010.00 | 1164986683 - PROFFER SURGICAL CENTER, PLLC | 823343890 - (TX) PROFFER SURGICAL CENTER PLLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26121 | $1597.00 | 1093786501 - SURGERY CENTER OF EASTON LP, HEALTHSOUTH SURGERY CENTER OF EASTON, L.P. | 721349755 - (MD) SURGERY CENTER OF EASTON LP | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26121 | $1700.00 | 1033734728 - ORANGE COUNTY SURGICAL CENTER | 851774434 - (CA) ORANGE COUNTY SURGICAL CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26121 | $780.00 | 1801094669 - CLEVELAND EYE AND LASER SURGERY CENTER LLC | 205487161 - (OH) CLEVELAND EYE & LASER SURGERY CENTER | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26121 | $1735.00 | 1932212511 - PALESTINE LASER & SURGERY CENTER PLLC | 470900270 - (TX) PALESTINE LASER SURGERY CENTER PLLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26121 | $950.00 | 1487014361 - GRIFFIN CENTER FOR PAIN AND SPINE | 814348805 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26121 | $6904.00 | 1558331801 - MEMORIAL HERMANN SURGERY CENTER, MEMORIAL HERMANN SURGERY CENTER, THE WOODLANDS | 201765863 - (TX) MEMORIAL HERMANN SURGERY CENTER | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26121 | $1800.00 | 1083382154 - TRI-CITY SURGICAL CENTERS, LLC | 825357044 - (AZ) TRICITY SURGICAL CENTERS LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26121 | $1530.00 | 1689059222 - GOLDSTEP AMBULATORY SURGERY CENTER, LLC | 465647464 - (NY) GOLDSTEP AMBULATORY SURGERY CENTER LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26121 | $1352.00 | 1396733945 - EYE LASER & SURGERY CENTER OF COLUMBUS, LLC | 640942234 - (MS) EYE LASER SURGERY CENTER OF COLUMBUS LLC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26121 | $1262.00 | 1013990308 - AUGUSTA PLASTIC SURGERY CENTER, INC. | 582227057 - (GA) AUGUSTA PLASTIC SURGERY CENTER INC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26121 | $4126.00 | 1558627406 - CARMEL SPECIALTY SURGERY CENTER LLC | 454729527 - (IN) CARMEL SPECIALTY SURGERY CENTER, LLC | IN | 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 26121 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 26121 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 26121 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 |
|---|---|---|
| 26121-CPT | Moderate | Fasciectomy, Palm Only, With Or Without Z-Plasty, Other Local Tissue Rearrangement, Or Skin Grafting (Includes Obtaining Graft) |
| 26123-CPT | High | Fasciectomy, Partial Palmar With Release Of Single Digit Including Proximal Interphalangeal Joint, With Or Without Z-Plasty, Other Local Tissue Rearrangement, Or Skin Grafting (Includes Obtaining Graft); |
| 26125-CPT | Moderate | Fasciectomy Partial Palmar With Release Of Single Digit Including Proximal Interphalangeal Joint With Or Without Z- Plasty Other Local Tissue Rearrangement Or Skin Grafting (Includes Obtaining Graft); Each Additional Digit (List Separately In Addition To Code For Primary Procedure) |
| 26340-CPT | Moderate | Manipulation, Finger Joint, Under Anesthesia, Each Joint |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 26121. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 26121 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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