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See a sample rate comparisonCPT 26530 Fee Schedule
Last Verified: October 2026
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.
Arthroplasty M-P Joint
| 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 RT - Right side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 26530 |
| Medicaid Fee Schedule | View Medicaid rates for 26530 |
National average reimbursement for CPT 26530 by major payers:
$716.38
$724.66
$758.31
$896.52
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CPT 26530
5 of 25 sample ratesHigher to lower in this preview
Saint Vincent Hlth Ctr Spu
Highmark Health
$18,799.47Published rateSurgery Centre Of Sw Florida LLC, Fort Myers Surgery Center
$5,020.00Published rateEssex Surgical Arts Surgery Center, LLC, Mobile Vascular Physicians
Essex Surgical Arts Surgery
$3,100.00Published rateAmbulatory Surgery Center Of Greater New York, LLC
$1,500.00Published rateHea Gramercy Surgery Center, PLLC, Hea Surgery Center
$632.00Published rate
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See a sample payer proposalCPT 26530 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 26530 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 26530 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 |
|---|---|---|
| 26520-CPT | Moderate | Capsulectomy Or Capsulotomy; Metacarpophalang Joint Ea Joint, Capsulectomy Or Capsulotomy; Metacarpophalangeal Joint Each Joint |
| 26525-CPT | Moderate | Capsulectomy I-P Joint |
| 26530-CPT | Moderate | Arthroplasty M-P Joint |
| 26531-CPT | Moderate | Arthroplst Metacarpophalang Joint; W/ Prosthet Implnt Ea, Arthroplasty Metacarpophalangeal Joint; With Prosthetic Implant Each |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 26530. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 26530 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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