CPT 26215 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 • F3 - Left hand, fourth digit • F9 - Right hand, fifth digit |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 26215 |
National average reimbursement for CPT 26215 by major payers:
$783.33
$756.75
$775.60
$955.26
| 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 26215 | ||||||
United | 26215 | $538.00 | 1770990376 - ADVANCED VISION SURGERY CENTER LLC | 453791209 - (VA) ADVANCED VISION SURGERY CENTER LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26215 | $1179.00 | 1043803877 - PALM BEACH INTERNATIONAL SURGERY CENTER LLC, PALM BEACH INTERNATIONAL SURGERY CENTER AT THE PALEY INSTITUTE | 384092545 - (FL) PALM BEACH INTERNATIONAL SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26215 | $1343.00 | 1720606932 - PHYSICIANS CLINIC INC | 470687317 - PHYSICIANS CLINIC INC | NE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26215 | $825.00 | 1497745178 - SURGERY CENTER, DBA SAWTOOTH SURGERY CENTER | 823348107 - (ID) SURGERY CENTER | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26215 | $755.00 | 1962695122 - NORTH ORANGE COUNTY SURGERY CENTER | 260625103 - (CA) NORTH ORANGE COUNTY SURGERY CENTER, LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26215 | $335.00 | 1164719209 - SURGICAL SPECIALISTS OF ST LUCIE, BLUE WATER SURGERY CENTER | 260176703 - (FL) SURGICAL SPECIALISTS OF ST. LUCIE COUNTY, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26215 | $800.00 | 1700369071 - ALLIANCE SURGERY CENTER AT MARIETTA, LLC | 831521891 - (GA) ALLIANCE SURGERY CENTER AT MARIETTA LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26215 | $253.00 | 1285736207 - PODIATRY GROUP OF ANNAPOLIS AMBULATORY SURGICAL CENTER, PODIATRY GROUP OF ANNAPOLIS AMBULATORY SURGICAL CENTER LLC | 522197193 - (MD) PODIATRY GROUP OF ANNAPOLIS AMBULATORY SURGICAL CENTER | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26215 | $647.00 | 1548296296 - ENT SURGERY CENTER OF AUGUSTA, LLC | 20577882 - (GA) ENT SURGERY CENTER OF AUGUSTA LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26215 | $800.00 | 1427545540 - ORBIS SURGERY CENTER LLC | 825184428 - (TX) ORBIS SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26215 | $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 | 26215 | $2279.00 | 1912993833 - SURGICENTER OF KANSAS CITY, LLC | 431828920 - (MO) SURGICENTER OF KANSAS CITY, LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26215 | $1276.00 | 1568967131 - CENTRAL MAINE EYE SURGERY CENTER LLC | 824811437 - (ME) CENTRAL MAINE EYE SURGERY CENTER LLC | ME | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26215 | $574.00 | 1568437820 - FLORIDA ENDOSCOPY AND SURGERY CENTER, LLC, FLORIDA ENDOSCOPY & SURGERY CENTER | 593622500 - (FL) FLORIDA ENDOSCOPY AND SURGERY CENTER, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26215 | $2817.00 | 1598769481 - MEMORIAL HERMANN SURGERY CENTER PRESTON ROAD, LTD., DOCTORS UNITED SURGERY CENTER | 752832459 - (TX) MEMORIAL HERMANN SURGERY CENTER PRESTON ROAD LTD | 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 26215 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 26215 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 26215 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 26215. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 26215 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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