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See a sample rate comparisonCPT 26428 Fee Schedule
Medicare rates as of October 2026
CPT 26428 is classified under Surgery, in the Surgical Procedures on the Musculoskeletal System subgroup.
Repair Graft Finger Tendon, Repair Of Extensor Tendon Central Slip Secondary Eg Boutonniere Deformity With Free Graft Includes Obtaining Graft Each Finger
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 24Ambulatory Surgical Center 22On Campus Outpatient Hospital |
| Common Modifiers | F9Right hand, fifth digit F7Right hand, third digit |
| Hospital Outpatient Group (APC) | APC 5113 - Level 3 Musculoskeletal Procedures |
| Surgery Center Payment (ASC) | A2 - Paid separately, from the OPPS relative weight |
| Common Revenue Codes | 0360 |
| Medicare Fee Schedule | $789.26 national non-facility rate (2026)View Medicare rates for 26428 |
| Medicaid Fee Schedule | $638.855 median of the 8 states in the free previewView Medicaid rates for 26428 |
National average reimbursement for CPT 26428 by major payers:
$1,026.64
BCBS / Anthem
$1,033.97
UnitedHealthcare
$1,061.77
Aetna
$1,299.87
Cigna
Compare published rates across providers.
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CPT 26428
5 of 25 sample ratesHigher to lower in this preview
East Mequon Surgery Center LLC
$9,270.00Published rateSurgcenter Of Glen Burnie, Surgcenter Of Glen Burnie, LLC
Surgcenter Of Glen Burnie, LLC
$3,500.00Published rateMvh Endoscopy LLC, Pcs Endoscopy Suite
Mvh Endoscopy LLC
$2,243.00Published rateSmart Pain Surgery Center At Owings Mills, LLC, Clearway Surgery Center Of Owings Mills
Smart Pain Surgery Center At Owings Mills LLC
$1,334.00Published rateTri-State Gastroenterology Associates, Psc, Tri-State Digestive Disorder Center
Tri-State Gastroenterology Associates, Psc
$734.00Published rate
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See a sample payer proposalCPT 26428 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The table lists codes related to 26428. Select one to see its fee schedule.
| Code | Description |
|---|---|
| 26428-CPT | Repair Graft Finger Tendon, Repair Of Extensor Tendon Central Slip Secondary Eg Boutonniere Deformity With Free Graft Includes Obtaining Graft Each Finger |
| 26432-CPT | Splint Injured Tendon, Treatment Of Finger Tendon Injury Using A Splint. Pins May Be Inserted Through The Skin To Stabilize The Finger Joint. |
| 26433-CPT | Repair Finger Tendon, Repair Of Finger Tendon On The Top Side Of The Hand (Extensor) Without A Graft Toward The End Of The Finger (Mallet Finger) |
| 26434-CPT | Repair/Graft Finger Tendon, Repair Of Finger Tendon On The Top Side Of The Hand (Extensor) Without A Graft Toward The End Of The Finger (Mallet Finger) With A Graft |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 26428. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 26428 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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Frequently Asked Questions
What APC is CPT 26428 assigned to?
Medicare's hospital outpatient payment system (OPPS) assigns CPT 26428 to APC 5113 (Level 3 Musculoskeletal Procedures). An APC groups outpatient services that Medicare pays at the same base rate.
How does Medicare pay for CPT 26428 in an ambulatory surgery center?
CMS lists CPT 26428 with ASC payment indicator A2: Paid separately, from the OPPS relative weight.
Which revenue codes are billed with CPT 26428?
Hospital price transparency files list CPT 26428 under these revenue codes: 0360. A revenue code names the hospital department or charge category for the line; it does not change what the service is.