CPT 26210 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 • F7 - Right hand, third digit • F2 - Left hand, third digit |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 26210 |
National average reimbursement for CPT 26210 by major payers:
$635.97
$594.72
$634.49
$758.23
| 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 26210 | ||||||
United | 26210 | $1248.00 | 1215531215 - HAUPPAUGE SC, LLC | 352651325 - (NY) HAUPPAUGE SC LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26210 | $515.00 | 1962500454 - BOLSA OUTPATIENT SURGERY CENTER A MEDICAL CORPORATION | 330655856 - (CA) BOLSA OUTPATIENT SURGERY CENTER A MEDICAL CORPORATION | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26210 | $2591.00 | 1477516979 - FAIRFAX SURGICAL CENTER, L.P. | 621861640 - (VA) FAIRFAX SURGICAL CENTER LP | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26210 | $475.00 | 1326084740 - ENDOSCOPY CENTER OF SW VA | 900165230 - (VA) ENDOSCOPY CENTER OF SW VA | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26210 | $450.00 | 1124075940 - ADVANCE ENDOSCOPY CENTER LLC | 510405251 - (DE) ADVANCE ENDOSCOPY CENTER LLC | DE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26210 | $1179.00 | 1790241073 - HSS PALM BEACH AMBULATORY SURGERY CENTER, LLC | 301015589 - (FL) HSS PALM BEACH AMBULATORY SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26210 | $550.00 | 1306435904 - ORTHOPAEDIC DEVELOPMENT PARTNERS LLC, ORTHOPAEDIC MEDICAL GROUP SURGERY CENTER | 851890498 - (FL) ORTHOPAEDIC DEVELOPMENT PARTNERS LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26210 | $981.00 | 1164986683 - PROFFER SURGICAL CENTER, PLLC | 823343890 - (TX) PROFFER SURGICAL CENTER PLLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26210 | $529.00 | 1215522727 - PREMIER 2020, LLC, PREMIER SURGICAL CENTER | 863194124 - (PA) PREMIER 2020 LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26210 | $1233.00 | 1548241623 - GASTROENTEROLOGY ASSOCIATES, LLC, GASTROENTEROLOGY ASSOCIATES ENDOSCOPY CENTER | 912104493 - (WA) GASTROENTEROLOGY ASSOCIATES PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26210 | $1285.00 | 1306556907 - THE VANCOUVER CLINIC INC PS, SALMON CREEK 2 AMBULATORY SURGERY CENTER | 910851599 - THE VANCOUVER CLINIC, INC., PS | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26210 | $605.00 | 1972578771 - SUN CITY AZ ENDOSCOPY ASC LLC, SUN CITY ENDOSCOPY CENTER | 201519369 - (AZ) SUN CITY AZ ENDOSCOPY ASC LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26210 | $1812.00 | 1104990050 - FOUR CORNERS AMBULATORY SURGERY CENTER, LLC | 911798298 - (NM) FOUR CORNERS AMBULATORY SURGERY CENTER, LLC | NM | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26210 | $3607.00 | 1730212879 - TEXAS HEALTH HARRIS METHODIST HOSPITAL SOUTHWEST FORT WORTH | 752678857 - (TX) TEXAS HEALTH HARRIS METHODIST HOSPITAL SOUTHWEST FORT WORTH | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26210 | $460.00 | 1225414246 - LV SURGERY CENTER LLC | 473021380 - (NV) LV SURGERY CENTER LLC | 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 26210 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 26210 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 26210 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 26210. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 26210 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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