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See a sample rate comparisonCPT 26130 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.
Removal Of Hand Joint Lining, Surgery To Remove Lining Of Hand Joint. The Procedure Is Done To Relieve Pain Caused By Inflamed Lining.
| 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 26130 |
| Medicaid Fee Schedule | View Medicaid rates for 26130 |
National average reimbursement for CPT 26130 by major payers:
$649.55
$622.36
$645.63
$773.60
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CPT 26130
5 of 25 sample ratesHigher to lower in this preview
Henry Ford Medical Center Fairlane, Henry Ford Health System
Henry Ford Health System
$5,672.00Published rateMiami Children'S Hospital Ambulatory Surgery Center, LLC
Miami Childrens Hospital Ambula
$840.00Published rateIdaho Physical Medicine And Rehabilitation PA
Idaho Physical Medicine & Rehabilitation, PA
$670.00Published rateSuncoast Eye Center PA, Suncoast Surgery Institute
Suncoast Eye Center PA
$450.00Published rateLaplata Ambulatory Urological Center, L.L.C.
Laplata Ambulatory Urological Center LLC
$356.00Published rate
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See a sample payer proposalCPT 26130 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 26130 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 26130 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 |
|---|---|---|
| 26100-CPT | Moderate | Hand Surgery For Biopsy, Surgery To Explore A Joint In The Hand. The Procedure Includes Removing A Sample Of Tissue For Testing (Biopsy). |
| 26105-CPT | Moderate | Hand Surgery For Biopsy, Surgery To Explore A Joint In The Hand. The Procedure Includes Removing A Sample Of Tissue For Testing (Biopsy). |
| 26110-CPT | Moderate | Finger Joint Exploration, Surgery To Explore A Finger Joint. The Procedure Removes A Sample Of Tissue For Testing (Biopsy). |
| 26130-CPT | Moderate | Removal Of Hand Joint Lining, Surgery To Remove Lining Of Hand Joint. The Procedure Is Done To Relieve Pain Caused By Inflamed Lining. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 26130. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 26130 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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