CPT 26426 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-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 • F4 - Left hand, fifth digit |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 26426 |
National average reimbursement for CPT 26426 by major payers:
$726.85
$729.74
$722.86
$894.07
| 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 26426 | ||||||
United | 26426 | $3171.00 | 1508197039 - FREEMAN SURGICAL CENTER LLC | 431704371 - FREEMAN HEALTH SYSTEM | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26426 | $1602.00 | 1083674196 - VISION CARE CENTER OF IDAHO LLC | 820516189 - (ID) VISION CARE CENTER OF IDAHO LLC | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26426 | $3623.00 | 1194723981 - GREENWOOD ASC LLC, GREENWOOD AMBULATORY SURGERY CENTER | 331021175 - (CO) GREENWOOD ASC LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26426 | $3570.00 | 1114926714 - ENDOSCOPY CENTER OF DAYTON LTD | 311460799 - (OH) ENDOSCOPY CENTER OF DAYTON LTD | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26426 | $1075.00 | 1992741300 - LINCOLN ENDOSCOPY CENTER, LLC | 470807741 - (NE) LINCOLN ENDOSCOPY CENTER LLC | NE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26426 | $1002.00 | 1841589116 - RENAISSANCE SURGERY CENTER OF CHATTANOOGA, LLC | 273013392 - (TN) RENAISSANCE SURGERY CENTER OF CHATTANOOGA LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26426 | $3500.00 | 1154323988 - CENTRAL VIRGINIA SURGI-CENTER LP, SURGI-CENTER OF CENTRAL VIRGINIA | 752967162 - (VA) CENTRAL VIRGINIA SURGICENTER LP | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26426 | $744.00 | 1659903292 - RACINE DIGESTIVE HEALTH CENTER LLC | 844211105 - (WI) RACINE DIGESTIVE HEALTH CENTER LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26426 | $5985.00 | 1962277483 - KC SURGICENTER, LLC | 372003878 - (MO) KC SURGICENTER LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26426 | $4143.10 | 1508213810 - ALEGENT CREIGHTON HEALTH, CHI HEALTH AMBULATORY SURGERY CENTER AT MIDLANDS | 470757164 - ALEGENT CREIGHTON HEALTH | NE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26426 | $1300.00 | 1215028469 - DEL VAL ASC LLC, THE EYE SURGERY CENTER | 760788813 - (PA) DEL VAL ASC LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26426 | $1119.00 | 1548249675 - ENDOSCOPY CENTER OF SANTA FE LP, THE ENDOSCOPY CENTER OF SANTA FE | 621548645 - (NM) ENDOSCOPY CENTER OF SANTA FE LP | NM | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26426 | $6300.00 | 1205945243 - FLORIDA ORTHOPAEDIC INSTITUTE SURGERY CENTER LLC | 593646134 - (FL) FLORIDA ORTHOPAEDIC INSTITUTE SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26426 | $2825.00 | 1114924685 - SOUTH KANSAS CITY SURGICAL CENTER, LC, SOUTH KANSAS CITY SURGICENTER | 202181884 - (KS) SOUTH KANSAS CITY SURGICAL CENTER, LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26426 | $2000.00 | 1366989741 - CENTER FOR SPINE INTERVENTIONS ASC 3, LLC | 813327243 | GA | 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 26426 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 26426 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 26426 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 |
|---|---|---|
| 26412-CPT | High | Rep Tendon Extensor Hand W Graft |
| 26415-CPT | High | Exten.Tendon Exc,Implnt Plas.Tube/Rod,Ha |
| 26416-CPT | High | Remov Rod W Insert Exten Tend Graft |
| 26426-CPT | Moderate | Repair Of Extensor Tendon, Central Slip, Secondary (Eg, Boutonniere Deformity); Using Local Tissue(S), Including Lateral Band(S), Each Finger |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 26426. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 26426 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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