CPT 26412 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 • LT - Left side of body • RT - Right side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 26412 |
National average reimbursement for CPT 26412 by major payers:
$1,002.10
$934.81
$965.16
$1,203.40
| 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 26412 | ||||||
United | 26412 | $4064.00 | 1386387116 - MADISON SURGICENTER LLC | 881205721 - (WI) MADISON SURGICENTER LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26412 | $2160.00 | 1093088999 - CHIPPENHAM AMBULATORY SURGERY CENTER, LLC | 371587067 - (VA) CHIPPENHAM AMBULATORY SURGERY CENTER LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26412 | $682.00 | 1518009430 - WELLBROOK ENDOSCOPY CENTER, LLC | 582258386 - (GA) WELLBROOK ENDOSCOPY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26412 | $2920.00 | 1932530284 - VP SURGERY CENTER OF AUBURN LLC | 371668651 - (WA) VP SURGERY CENTER OF AUBURN LLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26412 | $7149.00 | 1346649480 - HACIENDA OUTPATIENT SURGERY CENTER, LLC, HACIENDA SURGERY CENTER | 320439356 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26412 | $2095.00 | 1225036601 - TALLGRASS SURGICAL CENTER, LLC | 481243206 - (KS) TALLGRASS SURGICAL CENTER, LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26412 | $6342.00 | 1588629604 - GREENVILLE SURGERY CENTER, LLC, TEXAS HEALTH SURGERY CENTER DALLAS | 742411643 - (TX) GREENVILLE SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26412 | $2317.00 | 1730151168 - HAWTHORN PLACE OUTPATIENT SURGERY CENTER LP, HAWTHORN SURGERY CENTER | 582065044 - (IL) HAWTHORN PLACE OUTPATIENT SURGERY CENTER LP | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26412 | $2855.00 | 1336131143 - PHOENIX ORTHOPAEDIC AMBULATORY CENTER, LLC, GATEWAY SURGERY CENTER | 860970374 - (AZ) PHOENIX ORTHOPAEDIC AMBULATORY CENTER, LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26412 | $4339.00 | 1518375641 - NORTH ANAHEIM SURGERY CENTER, LLC | 364790127 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26412 | $683.00 | 1104125939 - GASTROENTEROLOGY CARE INC | 263101232 - (NY) GASTROENTEROLOGY CARE INC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26412 | $1260.00 | 1245346923 - AESTHETIC PLASTIC SURGERY INSTITUTE OF LOUISVILLE, LLC, LOUISVILLE SURGERY CENTER | 611464714 - (KY) AESTHETIC PLASTIC SURGERY INSTITUTE | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26412 | $2084.00 | 1588668503 - MIRAGE ENDOSCOPY CENTER, L.P. | 542077130 - (CA) MIRAGE ENDOSCOPY CENTER LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26412 | $535.41 | 1952708091 - EVAN LAHTINEN | 350593390 - DEACONESS HOSPITAL INC | FL | Certified Registered Nurse Anesthetist (367500000X) |
United | 26412 | $7825.00 | 1003897448 - NORTHWEST SURGERY CENTER LLC, FOOT & ANKLE SURGERY CENTER | 208754071 | 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 26412 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 26412 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 26412 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.
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 26412. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 26412 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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