CPT 26200 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 26200 |
National average reimbursement for CPT 26200 by major payers:
$627.96
$607.02
$622.49
$765.82
| 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 26200 | ||||||
United | 26200 | $1276.00 | 1407275282 - SURGCENTER CAMELBACK LLC | 464169482 - (AZ) SURGCENTER CAMELBACK LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26200 | $550.00 | 1164662912 - SPACE COAST SURGERY CENTER LLC | 263184352 - (FL) SPACE COAST SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26200 | $356.00 | 1386710937 - MONTGOMERY EYE CENTER, LLC, MONTGOMERY EYE CENTER AMBULATORY SURGERY CENTER | 591480588 - (FL) MONTGOMERY EYE CENTER, INC. | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26200 | $1276.00 | 1194723981 - GREENWOOD ASC LLC, GREENWOOD AMBULATORY SURGERY CENTER | 331021175 - (CO) GREENWOOD ASC LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26200 | $1528.00 | 1922510643 - OPTIMUM SPINE CENTER, LLC, PEACHTREE SPINE & PAIN PHYSICIANS | 320543789 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26200 | $780.00 | 1033271176 - HALLMARK SURGICAL CENTER OF NORTHRIDGE | 954683164 - (CA) NORTHRIDGE SURGERY AND PAIN MANAGEMENT CENTER, INC. | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26200 | $2259.00 | 1285202077 - SURGCENTER OF PINE RIDGE LLC | 853561528 - (FL) SURGCENTER OF PINE RIDGE LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26200 | $516.00 | 1306957485 - FAIRFAX COLON & RECTAL SURGERY CENTER, LLC | 510571797 | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26200 | $649.00 | 1477526689 - THE BLUE RIDGE CLEMSON ORTHOPAEDIC ASC LLC, BLUE RIDGE SURGERY CENTER | 621821015 - (SC) THE BLUE RIDGE CLEMSON ORTHOPAEDIC ASC LLC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26200 | $1528.00 | 1730713439 - FLORIDA SPRINGS SURGERY CENTER LLC | 832895293 - (FL) FLORIDA SPRINGS SURGERY CENTER L | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26200 | $499.00 | 1841368867 - DUBLIN EYE SURGERY CENTER LLC | 202788445 - (GA) DUBLIN EYE SURGERY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26200 | $711.00 | 1053508077 - JOURNEY LITE OF CINCINNATI, LLC | 208861350 - (OH) JOURNEYLITE OF CINCINNATI, LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26200 | $555.00 | 1770557233 - MESA AZ ENDOSCOPY ASC LLC, DESERT ENDOSCOPY CENTER | 510426858 - (AZ) THE MESA AZ ENDOSCOPY ASC, LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26200 | $1368.00 | 1194788182 - SURGICAL PARK CENTER LTD | 592827368 - (FL) SURGICAL PARK CENTER LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26200 | $721.00 | 1780322750 - QUEENSRIDGE SURGERY CENTER | 862358950 - (NV) QUEENSRIDGE SURGERY CENTER | NV | 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 26200 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 26200 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 26200 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 |
|---|---|---|
| 26200-CPT | Moderate | Exc Lesion Metacarpal |
| 26205-CPT | Moderate | Exc/Cur-Cyst/Tumr-Metacarpl;Autogft |
| 26210-CPT | Moderate | Exc Lesion Phalanx |
| 26215-CPT | Moderate | Excision Or Curettage Of Bone Cyst Or Benign Tumor Of Proximal, Middle, Or Distal Phalanx Of Finger; With Autograft (Includes Obtaining Graft) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 26200. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 26200 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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