CPT 26433 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 • F7 - Right hand, third digit |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 26433 |
National average reimbursement for CPT 26433 by major payers:
$767.91
$733.23
$768.60
$954.16
| 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 26433 | ||||||
United | 26433 | $1233.00 | 1467796730 - WINDSOR MILL SURGERY CENTER, LLC | 461412275 - (MD) WINDSOR MILL SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26433 | $645.00 | 1124587548 - GATEWAY SURGICAL CENTER, LLC | 830521568 - (TX) GATEWAY SURGICAL CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26433 | $927.00 | 1346596566 - SCP INDIANAPOLIS LLC | 460639908 | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26433 | $1451.00 | 1053565259 - SOUTHWEST LINCOLN SURGERY CENTER, LLC, SOUTHWEST LINCOLN SURGERY CENTER | 262981972 - (NE) SOUTHWEST LINCOLN SURGERY CENTER LLC | NE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26433 | $591.00 | 1033102140 - SSC HOLDINGS LLC, SEDONA SURGERY CENTER | 470887316 - (CA) SSC HOLDINGS LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26433 | $416.50 | 1902382757 - MARY GUTHRIE | 350593390 - DEACONESS HOSPITAL INC | IN | Nurse Practitioner (363L00000X) |
United | 26433 | $1400.00 | 1336649565 - ADVANCED SURGICAL CARE OF ST. LOUIS, LLC | 823086965 - (MO) ADVANCED SURGICAL CARE OF ST LOUIS LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26433 | $508.00 | 1861485138 - DISCOVER EYE SURGERY CENTER, LLC, EYE SURGERY CENTER - THE CLIFFS | 431909100 - (MO) DISCOVER EYE SURGERY CENTER LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26433 | $1276.00 | 1811385883 - CENTRAL DELAWARE ENDOSCOPY UNIT LLC | 471840129 | DE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26433 | $670.00 | 1609896539 - CEDAR HILLS AMBULATORY SURGERY CENTER LLC, CEDAR HILLS SURGERY CENTER | 680580628 - (OR) CEDAR HILLS AMBULATORY SURGERY CENTER LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26433 | $626.00 | 1003420001 - ON BEACH SURGERY CENTER, LLC | 831603088 - (CA) ON BEACH SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26433 | $414.00 | 1972147239 - CHILDREN'S SURGERY CENTER OF PHILADELPHIA LLC, CHILDREN'S DENTAL SURGERY OF PHILADELPHIA | 842886610 - (PA) CHILDRENS SURGERY CENTER OF PHILADELPHIA LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26433 | $925.15 | 1396990701 - PEACEHEALTH, ST JOSEPH MEDICAL CENTER | 910565889 - PEACEHEALTH ST JOSEPH MEDICAL CENTER | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26433 | $1258.00 | 1235395385 - TENN SM LLC | 680569923 - (TN) TENN SM LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26433 | $1000.00 | 1396796249 - TAMPA BAY SURGERY CENTER ASSOCIATES, LTD. | 593210851 - (FL) TAMPA BAY SURGERY CENTER ASSOC | FL | 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 26433 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 26433 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 26433 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 26433. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 26433 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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