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See a sample rate comparisonCPT 26434 Fee Schedule
Medicare rates as of October 2026
CPT 26434 is classified under Surgery, in the Surgical Procedures on the Musculoskeletal System subgroup.
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
| 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 | F7Right hand, third digit F2Left hand, third digit RTRight side of body |
| 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 | $693.40 national non-facility rate (2026)View Medicare rates for 26434 |
| Medicaid Fee Schedule | $561.625 median of the 8 states in the free previewView Medicaid rates for 26434 |
National average reimbursement for CPT 26434 by major payers:
$949.72
BCBS / Anthem
$886.98
UnitedHealthcare
$925.23
Aetna
$1,126.41
Cigna
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 26434.
CPT 26434
5 of 25 sample ratesHigher to lower in this preview
Texas Health Harris Methodist Hospital Fort Worth
Texas Health Harris Methodist Hospital Southwest Fort Worth
$9,098.00Published rateTamarac Surgery Center LLC, The Surgery Center Of Ft Lauderdale
Tamarac Surgery Center LLC
$3,623.00Published rateBanner Peoria Surgery Center LLC
$2,855.00Published rateAsc Development Company, LLC, National Spine And Pain Centers
Asc Development Company LLC
$1,763.00Published rateCentral Ohio Urology Surgery Center, LLC
Central Ohio Urology Surgery Center LLC
$1,056.00Published rate
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See a sample payer proposalCPT 26434 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The table lists codes related to 26434. 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 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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Frequently Asked Questions
What APC is CPT 26434 assigned to?
Medicare's hospital outpatient payment system (OPPS) assigns CPT 26434 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 26434 in an ambulatory surgery center?
CMS lists CPT 26434 with ASC payment indicator A2: Paid separately, from the OPPS relative weight.
Which revenue codes are billed with CPT 26434?
Hospital price transparency files list CPT 26434 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.