CPT 26250 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address high-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 | • 22 - On Campus Outpatient Hospital • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • RT - Right side of body • LT - Left side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 26250 |
National average reimbursement for CPT 26250 by major payers:
$1,338.68
$1,297.23
$1,400.38
$1,683.67
| 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 26250 | ||||||
United | 26250 | $2307.00 | 1477846145 - INDIANA UNIVERSITY HEALTH SAXONY SURGERY CENTER LLC, SAXONY SURGERY CENTER | 352072586 | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26250 | $879.00 | 1831217231 - THE ENDOSCOPY CENTER AT BAINBRIDGE LLC | 205430025 - (OH) THE ENDOSCOPY CENTER AT BAINBRIDGE LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26250 | $491.00 | 1114990736 - TULSA OK OPHTHALMOLOGY ASC LLC, EYE SURGERY CENTER OF TULSA | 743051552 | OK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26250 | $2270.00 | 1619974219 - ST. JOSEPH'S SURGERY CENTER LP | 201019390 - (CA) ST JOSEPHS SURGERY CENTER LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26250 | $1500.00 | 1750567442 - IRELAND GROVE CENTER FOR SURGERY LLC. | 202687982 - (IL) IRELAND GROVE CENTER FOR SURGERY, LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26250 | $1276.00 | 1821421256 - MONOCACY SURGERY CENTER LLC | 462861862 - (MD) MONOCACY SURGERY CENTER | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26250 | $1344.00 | 1295790327 - ENDOSCOPY OF PLANO, LP, GASTROINTESTINAL ENDOSCOPY CENTER OF PLANO | 201477775 - (TX) ENDOSCOPY OF PLANO LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26250 | $1886.00 | 1821249616 - LINCOLN SURGERY CENTER LLC | 261790900 - (CO) LINCOLN SURGERY CENTER, LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26250 | $640.00 | 1619051760 - GREENVILLE ENDOSCOPY CENTER INC | 570965754 - (SC) GREENVILLE ENDOSCOPY CENTER INC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26250 | $477.00 | 1043473390 - LAKEWOOD EYE PHYSICIANS AND SURGEONS INC A MEDICAL GROUP | 952858745 - (CA) LAKEWOOD EYE PHYSICIANS & SURGEONS, INC. | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26250 | $602.00 | 1386739498 - GEORGIA LITHOTRIPSY AND LASER CENTER | 581879891 - (GA) GEORGIA LITHOTRIPSY AND LASER CENTER | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26250 | $2007.00 | 1821242488 - SPECIALTY SURGICAL CENTER OF NORTH BRUNSWICK, LLC | 208770654 - (NJ) SPECIALTY SURGICAL CENTER OF N | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26250 | $721.00 | 1205908456 - ENDOSCOPY CENTER -PINEVILLE LLC, CAROLINA ENDOSCOPY CENTER -PINEVILLE | 260317153 - (NC) ENDOSCOPY CENTER PINEVILLE LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26250 | $1849.00 | 1982053054 - WEBSTER AMBULATORY SURGERY CENTER, LP, LANDMARK SURGERY CENTER | 205953387 | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26250 | $624.00 | 1215178835 - PACIFIC CATARACT AND LASER INSTITUTE, INC., P.C. | 911394965 - PACIFIC CATARACT AND LASER INSTITUTE, INC., PC | WA | 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 26250 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 26250 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 26250 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 Excision (Craterization, Saucerization, Or Diaphysectomy) Of Bone (Eg, For Osteomyelitis); Distal Phalanx Of |
| 26250-CPT | High | Resect Metacarpal Radical |
| 26260-CPT | High | Radical Resection Proximal Or Middle Phalanx Of Finger (Eg Tumor); |
| 26262-CPT | Moderate | Radical Resection Distal Phalanx Of Finger (Eg Tumor) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 26250. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 26250 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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