Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonCPT 26185 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.
Sesamoidectomy, Thumb Or Finger
| 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 59 - Distinct Procedural Service F5 - Right hand, thumb |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 26185 |
| Medicaid Fee Schedule | View Medicaid rates for 26185 |
National average reimbursement for CPT 26185 by major payers:
$784.84
$723.64
$746.80
$903.74
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 26185.
CPT 26185
5 of 25 sample ratesHigher to lower in this preview
Center For Ambulatory Surgery, LLC, The Center For Ambulatory Surgery
The Center For Ambulatory Surgery LLC
$3,010.00Published rateCharlotte Endoscopic Surgery Center LLC, Charlotte Surgery Center
Charlotte Endoscopic Surgery Center, LLC
$1,233.00Published rateHanover Surgicenter, L.L.C.
$711.00Published rateDay Surgery Of Grand Junction LLC, Day Surgery Of Grand Junction
Day Surgery Of Grand Junction LLC
$555.00Published rateMountain Home Surgery Center, Inc.
$373.00Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 26185 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 26185 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 26185 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 |
|---|---|---|
| 26185-CPT | Moderate | Sesamoidectomy, Thumb Or Finger |
| 26320-CPT | Moderate | Remove Implant Fingeror Hand |
| 26340-CPT | Moderate | Finger Joint Physical Therapy, Manual Stretching And Rotation Of A Finger Joint Under Anesthesia To Regain Range Of Motion. |
| 26352-CPT | High | Repair Graft Hand Tendon, Repair Or Advancement Flexor Tendon Not In Zone 2 Digital Flexor Tendon Sheath Eg No Man S Land Secondary With Free Graft Includes Obtaining Graft Each Tendon |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 26185. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 26185 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.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 26185) and we'll show you how you compare in 15 minutes or less.