CPT 26185 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 • 59 - Distinct Procedural Service • F5 - Right hand, thumb |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 26185 |
National average reimbursement for CPT 26185 by major payers:
$784.84
$723.64
$746.80
$924.93
| 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 26185 | ||||||
United | 26185 | $373.00 | 1497029466 - MOUNTAIN HOME SURGERY CENTER, INC. | 454157268 | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26185 | $417.00 | 1467582437 - NORTH FLORIDA SURGERY CENTER INC, NORTH FLORIDA SURGERY CENTER | 593377918 - (FL) NORTH FLORIDA SURGERY CENTER INC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26185 | $3010.00 | 1427049352 - CENTER FOR AMBULATORY SURGERY, LLC, THE CENTER FOR AMBULATORY SURGERY | 223638149 - (NJ) THE CENTER FOR AMBULATORY SURGERY LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26185 | $555.00 | 1346308954 - DAY SURGERY OF GRAND JUNCTION LLC, DAY SURGERY OF GRAND JUNCTION | 841097113 - (CO) DAY SURGERY OF GRAND JUNCTION LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26185 | $585.50 | 1275184293 - JOHNS HOPKINS SURGERY CENTERS SERIES, BEL AIR SURGERY CENTER | 208707724 - (MD) JOHNS HOPKINS SURGERY CENTER SERIES | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26185 | $711.00 | 1174525661 - HANOVER SURGICENTER, L.L.C. | 562533573 | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26185 | $800.00 | 1922438472 - PARK AMBULATORY SURGERY CENTER, LLC | 463665760 - (TX) PARK AMBULATORY SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26185 | $814.00 | 1750036174 - GLACIER SURGICAL INC. | 861271667 | MT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26185 | $725.00 | 1497105803 - GEORGIA INTERVENTIONAL PAIN | 812947115 - (GA) GEORGIA INTERVENTIONAL PAIN | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26185 | $520.00 | 1629107545 - LANIER EYE ASSOCIATES, LLC, ADVANCED EYE SURGERY AND LASER CENTER | 50559435 - (GA) LANIER EYE ASSOCIATES LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26185 | $1258.00 | 1932636123 - TUCSON DIGESTIVE INSTITUTE LLC, ARIZONA DIGESTIVE INSTITUTE | 821568426 | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26185 | $1928.00 | 1316395270 - IRVINE SURGICAL PARTNERS LLC | 812776218 - (CA) IRVINE SURGICAL PARTNERS LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26185 | $626.00 | 1174063788 - EMBASSY SURGERY CENTER, LLC | 815164569 - (CA) EMBASSY SURGERY CENTER, LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26185 | $721.00 | 1750974176 - NCBH OUTPATIENT ENDOSCOPY CENTER, L.L.C., WAKE FOREST BAPTIST HEALTH OUTPATIENT ENDOSCOPY - QUAKER LANE | 270668137 - (NC) NCBH OUTPATIENT ENDOSCOPY CENTER LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26185 | $650.00 | 1952398141 - AUSTIN EYE CLINIC ASSOCIATION, AUSTIN EYE LASER AND SURGICENTER | 741677021 - (TX) AUSTIN EYE CLINIC ASSOCIATION | TX | 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 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 | Manipulation, Finger Joint, Under Anesthesia, Each Joint |
| 26352-CPT | High | 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.
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