CPT 26358 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 • RT - Right side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 26358 |
National average reimbursement for CPT 26358 by major payers:
$1,348.45
$1,306.36
$1,341.17
$1,640.31
| 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 26358 | ||||||
United | 26358 | $2175.00 | 1073081501 - MILFORD-FRANKLIN EYE CENTER, LLC | 43287594 - (MA) MILFORD-FRANKLIN EYE CENTER, LLC | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26358 | $1200.00 | 1679521389 - WESLEY & KLIPPENSTEIN, PC, WESLEY OPHTHALMIC PLASTIC SURGERY CENTER | 621799761 - (TN) WESLEY & KLIPPENSTEIN, P.C. | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26358 | $1730.00 | 1487978789 - CENTER OF MOREHEAD CITY, LLC, THE SURGICAL CENTER OF MOREHEAD CITY | 272095799 - (NC) SURGICAL CENTER OF MOREHEAD | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26358 | $1175.00 | 1629107545 - LANIER EYE ASSOCIATES, LLC, ADVANCED EYE SURGERY AND LASER CENTER | 50559435 - (GA) LANIER EYE ASSOCIATES LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26358 | $3353.00 | 1295776920 - ROSE AMBULATORY SURGERY CENTER LP | 200415436 - (CO) ROSE AMBULATORY SURGERY CENTER LP | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26358 | $3347.00 | 1790344182 - BRISTOL AMBULATORY SURGERY CENTER, LLC | 834345983 | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26358 | $1658.00 | 1487609335 - THE CENTER FOR AESTHETIC SURGERY LLC | 200431536 - (MD) THE CENTER FOR AESTHETIC SURGERY LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26358 | $1854.00 | 1184072308 - MARYLAND SURGERY CENTER FOR WOMEN | 522215638 - (MD) MARYLAND SURGERY CENTER FOR WOMEN, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26358 | $2434.00 | 1528021573 - SUMMIT SURGERY CENTER LP | 621777535 - (TN) SUMMIT SURGERY CENTER LP | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26358 | $717.00 | 1184675704 - DOCTORS SURGERY CENTER LLC | 593518740 - (FL) DOCTORS SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26358 | $3500.00 | 1477700516 - SUMMIT AMBULATORY SURGICAL CENTER LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26358 | $2653.00 | 1275060303 - CAPITAL NEPHROLOGY ACCESS CENTER, LLC | 814942280 - (CA) CAPITAL NEPHROLOGY ACCESS CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26358 | $1486.00 | 1932183266 - SINGLE DAY SURGERY CENTER LLC | 880504513 - (NV) SINGLE DAY SURGERY CENTER LLC | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26358 | $1710.01 | 1821155532 - LARRY CRICK | 350593390 - DEACONESS HOSPITAL INC | KY | Pediatrics Physician (208000000X) |
United | 26358 | $3000.00 | 1376054007 - HUDSON YARDS SURGERY CENTER, LLC, HUDSON SPECIALTY SURGERY CENTER | 463753455 - (NY) HUDSON YARDS SURGERY CENTER LLC | NY | 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 26358 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 26358 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 26358 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 26358. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 26358 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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