CPT 26236 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 26236 |
| Medicaid Fee Schedule | View Medicaid rates for 26236 |
National average reimbursement for CPT 26236 by major payers:
$606.95
$592.46
$623.21
$731.58
CPT 26236 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 26236 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 26236 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 |
|---|---|---|
| 26236-CPT | Moderate | Partial Removal Finger Bone, Partial Excision Craterization Saucerization Or Diaphysectomy Bone Eg Osteomyelitis Distal Phalanx Of Finger |
| 26250-CPT | High | Resect Metacarpal Radical |
| 26260-CPT | High | Radical Resct Of Tumor Proxim Or Middle Phalanx Of Finger, Radical Resection Of Tumor Proximal Or Middle Phalanx Of Finger |
| 26262-CPT | Moderate | Radical Resct Of Tumor Distal Phalanx Of Finger, Radical Resection Of Tumor Distal Phalanx Of Finger |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 26236. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 26236 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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