CPT 26372 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 • AS - PA/NP/CNS assistant at surgery |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 26372 |
National average reimbursement for CPT 26372 by major payers:
$1,208.77
$1,212.78
$1,232.14
$1,541.83
| 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 26372 | ||||||
United | 26372 | $2441.00 | 1649252883 - FOUNDATION SURGERY AFFILIATE OF NACOGDOCHES LLC, NACOGDOCHES SURGERY CENTER | 731589339 - (TX) FOUNDATION SURGERY AFFILIATE OF NACOGDOCHES LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26372 | $1831.00 | 1154412120 - SURGICORE, INC. | 363567890 - (IL) SURGICORE INC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26372 | $843.00 | 1114312659 - UNITED SHOCKWAVE SERVICES, LTD., UNITED THERAPIES | 363415474 | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26372 | $3952.00 | 1588656508 - SAINT THOMAS CAMPUS SURGICARE LP | 752959131 - (TN) SAINT THOMAS CAMPUS SURGICARE LP | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26372 | $1300.00 | 1225510159 - SOUTHWEST SURGERY CENTER LLC | 825304896 | UT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26372 | $2280.00 | 1386647402 - PHYSICIANS DAY SURGERY CENTER, LLC, PHYSICIANS DAY SURGERY CENTER, INC. | 593438026 - (FL) PHYSICIANS DAY SURGERY CENTER, INC. | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26372 | $3500.00 | 1245427228 - SUMMIT AMBULATORY SURGICAL CENTER, LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26372 | $2855.00 | 1962938332 - BANNER UNION HILLS SURGERY CENTER LLC | 901164193 - (AZ) BANNER UNION HILLS SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26372 | $6904.00 | 1033586136 - PHYSICIANS WEST HOUSTON SURGICAL CENTER, LLC, MEMORIAL HERMANN SURGERY CENTER PARK TEN | 371789833 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26372 | $1763.00 | 1770019200 - GEORGIA CATARACT AND EYE SPECIALTY CENTER LLC, GEORGIA CATARACT AND EYE SPECIALTY CENTER | 461115901 - (GA) GEORGIA CATARACT AND EYE SPECIALTY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26372 | $2100.00 | 1043760184 - AUBURN SURGERY CENTER INC | 431937843 - (MO) AUBURN SURGERY CENTER INC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26372 | $3305.00 | 1992497762 - SEATTLE SURGERY CENTER LLC | 882819593 | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26372 | $1750.00 | 1912447418 - LUBBOCK SURGERY CENTER, LLC | 812766547 - (TX) LUBBOCK SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26372 | $660.00 | 1376592204 - PALMETTO ENDOSCOPY CENTER LLC | 571195554 - (SC) PALMETTO ENDOSCOPY CENTER LLC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26372 | $3623.00 | 1154497964 - PANKRATZ EYE INSTITUTE, LLC, COLUMBUS EYE SUGERY CENTER, LLC, DBA PANKRATZ EYE INSTITUTE | 352092292 - (IN) PANKRATZ EYE INSTITUTE LLC | IN | 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 26372 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 26372 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 26372 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 |
| 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 |
| 26370-CPT | High | Rep Tendon Profundus Primary |
| 26372-CPT | High | Repair Or Advancement Of Profundus Tendon, With Intact Superficialis Tendon; 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 26372. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 26372 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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