CPT 26434 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 • F7 - Right hand, third digit • F2 - Left hand, third digit • RT - Right side of body |
| Complexity Level | Moderate |
National average reimbursement for CPT 26434 by major payers:
$949.72
$886.98
$925.23
$1,151.37
| 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 26434 | ||||||
United | 26434 | $2074.00 | 1093595696 - NEW LEXINGTON CLINIC PSC, DERMATOLOGY ASSOCIATES OF KENTUCKY PSC | 611262927 - (KY) NEW LEXINGTON CLINIC, P.S.C. | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26434 | $2334.00 | 1902078207 - PLAINFIELD SURGERY CENTER, LLC | 300391104 - (IL) PLAINFIELD SURGERY CENTER LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26434 | $1380.00 | 1295365864 - NORTH FORK SURGERY CENTER LLC | 813251284 - (NY) NORTH FORK SURGERY CENTER LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26434 | $6399.00 | 1336288703 - VIRGINIA MASON MEDICAL CENTER, VIRGINIA MASON ISSAQUAH ASC | 910565539 - (WA) VIRGINIA MASON MEDICAL CENTER | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26434 | $2475.00 | 1922438472 - PARK AMBULATORY SURGERY CENTER, LLC | 463665760 - (TX) PARK AMBULATORY SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26434 | $1823.00 | 1144370784 - BELLINGHAM EAR NOSE THROAT AND FACIAL SURGERY INC, WHATCOM SURGERY CENTER | 911009308 - (WA) BELLINGHAM EAR, NOSE, THROAT & FACIAL PLASTIC SURGERY, INC. P.S. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26434 | $2267.00 | 1275008351 - CENTER FOR SPECIAL SURGERY LLC | 830951938 - (GA) CENTER FOR SPECIAL SURGERY LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26434 | $1750.00 | 1437691177 - FRESENIUS VASCULAR CARE CINCINNATI ASC LLC, AZURA SURGERY CENTER CINCINNATI | 814225843 - (OH) FRESENIUS VASCULAR CARE CINCINNATI ASC LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26434 | $3623.00 | 1194724690 - ENDOSCOPY CENTER OF DAYTON NORTH LLC | 311703317 - (OH) ENDOSCOPY CENTER OF DAYTON NORTH LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26434 | $2200.00 | 1619036381 - WILMINGTON AMBULATORY SURGICAL CENTER, LLC, AMERICAN SURGERY CENTER | 510385184 - (DE) WILMINGTON AMBULATORY SURGICAL CENTER LLC | DE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26434 | $3347.00 | 1588260343 - ADVENTHEALTH SURGERY CENTER WELLSWOOD LLC, ADVENTHEALTH SURGERY CENTER WELLSWOOD | 854111089 - (FL) ADVENTHEALTH SURGERY CENTER WELLSWOOD LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26434 | $1500.00 | 1023072824 - SOUTH JERSEY EYE PHYSICIANS, LLC, THE SURGICAL CENTER AT SOUTH JERSEY EYE PHYSICIANS, PA | 222116946 - (NJ) SOUTH JERSEY EYE PHYSICIANS, PA | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26434 | $2122.00 | 1962402503 - NORTH KITSAP AMBULATORY SURGERY CENTER, LLC, PACIFIC SURGERY CENTER | 911276412 - (WA) NORTH KITSAP AMBULATORY CENTER, INC. DBA PACIFIC SURGERY CENTER | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26434 | $2500.00 | 1255397808 - JOLIET SURGERY CENTER LIMITED PARTNERSHIP, AMSURG SURGERY CENTER | 742544709 - (IL) JOLIET SURGERY CENTER LIMITED PARTNERSHIP | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26434 | $2576.00 | 1336107580 - POMERADO OUTPATIENT SURGICAL CENTER L P, PALOMAR SURGICAL CENTER ESCONDIDO | 330752699 - (CA) POMERADO OUTPATIENT SURGICAL CENTER L P | CA | 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 26434 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 26434 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 26434 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 26434. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 26434 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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