CPT 26428 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 • F7 - Right hand, third digit |
| Complexity Level | High |
National average reimbursement for CPT 26428 by major payers:
$1,026.64
$1,033.97
$1,061.77
$1,328.27
| 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 26428 | ||||||
United | 26428 | $6225.00 | 1023359627 - THE EMORY CLINIC INC., EMORY AESTHETIC CENTER | 582030692 - EMORY UNIVERSITY | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26428 | $1638.00 | 1598952061 - ENDOSCOPY ASSOCIATES, LLC | 142006705 - (VA) ENDOSCOPY ASSOCIATES LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26428 | $1531.00 | 1992034763 - CENTRAL ARKANSAS SURGICAL CENTER, LLC | 270564540 - (AR) CENTRAL ARKANSAS SURGICAL CENTER LLC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26428 | $734.00 | 1487651956 - TRI-STATE GASTROENTEROLOGY ASSOCIATES, PSC, TRI-STATE DIGESTIVE DISORDER CENTER | 611192347 - (KY) TRI-STATE GASTROENTEROLOGY ASSOCIATES, PSC | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26428 | $3347.00 | 1730318353 - GARDENDALE SURGICAL ASSOCIATES, LLC | 205936644 - (AL) GARDENDALE SURGICAL ASSOCIATES | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26428 | $3705.00 | 1437202249 - PACMED CLINICS | 562290878 - (WA) PACMED CLINICS | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26428 | $1786.00 | 1386677326 - INLAND EYE SPECIALISTS A MEDICAL CORP, INLAND EYE SPECIALISTS | 330585144 - (CA) INLAND EYE SPECIALISTS, A MEDICAL CORPORATION | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26428 | $2100.00 | 1407824436 - ORAL FACIAL SURGERY CENTER, LLC, SPECIALTY SURGERY CENTER | 621488965 - (TN) ORAL FACIAL SURGERY CENTER, INC. | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26428 | $3305.00 | 1992497762 - SEATTLE SURGERY CENTER LLC | 882819593 | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26428 | $885.00 | 1609983477 - NORTH GEORGIA ENDOSCOPY CENTER INC | 582070246 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26428 | $585.00 | 1205454626 - EYE SURGERY CENTER OF WISCONSIN, LLC | 833779684 - (WI) EYE SURGERY CENTER OF WISCONSIN, LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26428 | $3090.00 | 1700966710 - SURGERY CENTER OF KALAMAZOO LLC | 61694249 - (MI) SURGERY CENTER OF KALAMAZOO LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26428 | $750.00 | 1619517539 - MOUNTAIN WEST DERM | 813253496 | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26428 | $2000.00 | 1295204113 - HUNTINGTON SPECIALTY SURGERY LLC | 831389054 - (CA) HUNTINGTON SPECIALTY SURGERY LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26428 | $2080.00 | 1952776098 - BAYTOWN ASC, LP, BAYTOWN HEART & VASCULAR SURGERY CENTER | 474501044 - (TX) BAYTOWN ASC LP | TX | 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 26428 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 26428 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 26428 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 |
|---|---|---|
| 26428-CPT | High | Repair Of Extensor Tendon, Central Slip, Secondary (Eg, Boutonniere Deformity); With Free Graft (Includes Obtaining Graft), Each Finger |
| 26432-CPT | Moderate | Extensor Tendon Repair, Distal Insertion (''mallet Finger''), Closed, Splinting With Or Without Percutaneous Pin |
| 26433-CPT | Moderate | Rep Tendon Extensor Finger Open |
| 26434-CPT | Moderate | Extensor Tendon Repair, Distal Insertion ( Mallet Finger ), Open, Primary Or Secondary Repair; With Free Graft (Include |
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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