CPT 26357 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 | • 24 - Ambulatory Surgical Center • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • F9 - Right hand, fifth digit • F1 - Left hand, second digit |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 26357 |
National average reimbursement for CPT 26357 by major payers:
$1,181.48
$1,199.37
$1,229.59
$1,501.70
| 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 26357 | ||||||
United | 26357 | $1278.00 | 1164012142 - COMPREHENSIVE DIGESTIVE SURGICENTER, LLC, COMPREHENSIVE DIGESTIVE SURGICAL CENTER | 854015524 - (NV) COMPREHENSIVE DIGESTIVE SURGICENTER LLC | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26357 | $3546.00 | 1205364981 - MERCED AMBULATORY SURGERY CENTER, LLC, UNIVERSITY SURGERY CENTER | 611845381 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26357 | $912.00 | 1487782637 - EYEASSOCIATES SURGERY CENTER, INC | 581362384 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26357 | $1609.00 | 1366635609 - APPLE SURGERY CENTER, INC | 260423287 - (CA) APPLE SURGERY CENTER INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26357 | $3623.00 | 1659517019 - SURGERY CENTER OF PEMBROKE PINES, LLC | 263364068 - (FL) SURGERY CENTER OF PEMBROKE | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26357 | $2547.00 | 1568423945 - NW AMBULATORY SURGERY CENTER LLP, NW SURGERY CENTER | 383693604 - (TX) NW AMBULATORY SURGERY CENTER LLP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26357 | $6941.00 | 1285912600 - THE EMORY CLINIC INC, THE EMORY CLINIC LAGRANGE SURGERY CENTER | 582030692 - EMORY UNIVERSITY | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26357 | $595.00 | 1952373086 - CRYSTAL RIVER ENDOSCOPY ASC LP, CITRUS ENDOSCOPY & SURGERY CENTER | 621666148 - (FL) CRYSTAL RIVER ENDOSCOPY ASC LP | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26357 | $3244.00 | 1316939556 - SEQUOIA SURGICAL CENTER LP, SEQUOIA SURGICAL PAVILION | 364408212 - (CA) SEQUOIA SURGICAL CENTER LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26357 | $1759.00 | 1811378375 - ALEXANDRIA AMBULATORY SURGERY CENTER LP, ALEXANDRIA HEART & VASCULAR SURGERY CENTER | 471533012 | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26357 | $4890.00 | 1861538613 - CENTRACARE SURGERY CENTER, LLC | 611514974 | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26357 | $1862.00 | 1730374307 - NORTHVIEW ORTHOPAEDIC SURGERY CENTER, P.C. | 261245423 - (GA) NORTHVIEW ORTHOPAEDIC SURGERY CENTER PC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26357 | $663.00 | 1265442537 - BRIGHTON SURGERY CENTER, LLC | 743060570 - (NY) BRIGHTON SURGERY CENTER, LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26357 | $2350.00 | 1316604440 - GEORGIA INTERVENTIONAL PAIN | 862695318 - (GA) GEORGIA INTERVENTIONAL PAIN | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26357 | $2061.00 | 1831766955 - SOUTHEASTERN SURGICAL, LLC, RIVERFRONT SURGERY CENTER | 833821506 - (TN) SOUTHEASTERN SURGICAL LLC | TN | 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 26357 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 26357 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 26357 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 |
|---|---|---|
| 26352-CPT | High | Repair Or Advancement, Flexor Tendon, Not In Zone 2 Digital Flexor Tendon Sheath (Eg, No Man S Land); Secondary With Free Graft (Includes Obtaining Graft), Each Tendon |
| 26356-CPT | High | Repair Or Advancement Flexor Tendon In Zone 2 Digital Flexor Tendon Sheath (Eg No Mans Land); Primary Without Free Graft Each Tendon(Rvsd 1/1/04 ) |
| 26357-CPT | High | Repair Or Advancement Flexor Tendon In Zone 2 Digital Flexor Tendon Sheath (Eg No Mans Land); Secondary Without Free Graft Each Tendon (Rvsd 1/1/04) |
| 26358-CPT | High | Repair Or Advancement, Flexor Tendon, In Zone 2 Digital Flexor Tendon Sheath (Eg, No Man S Land); Secondary, With Free Graft (Includes Obtaining Graft), Each Tendon |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 26357. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 26357 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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