CPT 26123 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address high-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 • F9 - Right hand, fifth digit • F4 - Left hand, fifth digit |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 26123 |
National average reimbursement for CPT 26123 by major payers:
$1,127.60
$1,110.01
$1,196.19
$1,403.12
| 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 26123 | ||||||
United | 26123 | $2956.00 | 1366456618 - SKYWAY SURGERY CENTER. LLC | 753035490 - (CA) SKYWAY SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26123 | $679.00 | 1801869292 - AMSURG NORTHERN KENTUCKY GI LLC, ST. ELIZABETH PHYSICIANS ENDOSCOPY CENTER | 621719097 | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26123 | $788.00 | 1376574814 - ROCHESTER ENDOSCOPY & SURGERY CENTER, L.L.C. | 61683897 - (MI) ROCHESTER ENDOSCOPY SURGERY CENTER LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26123 | $602.00 | 1740210459 - SOUTH CAROLINA ENDOSCOPY CENTER | 562069531 - (SC) S.C. ENDOSCOPY CENTER LLC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26123 | $1337.00 | 1962455964 - CYPRESS SURGERY CENTER LLC | 481214301 - (KS) CYPRESS SURGERY CENTER LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26123 | $1317.00 | 1164597761 - OUTPATIENT EYE SURGERY CENTER | 721098835 - (LA) OUTPATIENT EYE SURGERY CENTER | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26123 | $3623.00 | 1316109309 - PROLIANCE SURGEONS INC PS, PLASTIC & RECONSTRUCTIVE SURGEONS ASC | 911606533 - (WA) PROLIANCE SURGEONS, INC., P.S. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26123 | $2924.00 | 1497706626 - CHICAGO PROSTATE CANCER SURGERY CENTER, LLC, DUPAGE MEDICAL GROUP SURGERY CENTER, WESTMONT | 204403852 - (IL) CHICAGO PROSTATE CANCER SURGERY CENTER LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26123 | $2688.00 | 1205152618 - MINNESOTA EYE LASER & SURGERY CENTERS, LLC, MINNESOTA EYE LASER & SURGERY CENTERS | 460505033 - (MN) MINNESOTA EYE LASER SURGERY CENTERS LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26123 | $2021.00 | 1407188659 - LIMESTONE SURGERY CENTER LLC | 271490855 - (GA) LIMESTONE SURGERY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26123 | $1693.00 | 1902802036 - CATARACT & SURGICAL CENTER OF LUBBOCK LLC | 522344594 - (TX) CATARACT SURGICAL CENTER OF LUBBOCK LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26123 | $2570.00 | 1477590719 - HASTINGS SURGICAL CENTER, LLC, HASTINGS SURGICAL CENTER | 201507841 - (NE) HASTINGS SURGICAL CENTER LLC | NE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26123 | $1550.00 | 1053388223 - THE OCULAR SURGERY CENTER, LLC | 742462970 - (TX) THE OCULAR SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26123 | $3623.00 | 1154497964 - PANKRATZ EYE INSTITUTE, LLC, COLUMBUS EYE SUGERY CENTER, LLC, DBA PANKRATZ EYE INSTITUTE | 352092292 - (IN) PANKRATZ EYE INSTITUTE LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26123 | $2720.00 | 1063058303 - CHESAPEAKE REGIONAL SURGERY CENTER AT VIRGINIA BEACH, LLC | 843621271 - (VA) CHESAPEAKE REGIONAL SURGERY CENTER AT VIRGINIA BEACH LLC | VA | 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 26123 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 26123 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 26123 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 26123. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 26123 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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