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See a sample rate comparisonCPT 26531 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.
Arthroplst Metacarpophalang Joint; W/ Prosthet Implnt Ea, Arthroplasty Metacarpophalangeal Joint; With Prosthetic Implant Each
| 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 26531 |
| Medicaid Fee Schedule | View Medicaid rates for 26531 |
National average reimbursement for CPT 26531 by major payers:
$828.14
$842.88
$892.88
$1,042.51
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CPT 26531
5 of 25 sample ratesHigher to lower in this preview
Virginia Mason Medical Center, Virginia Mason Lynnwood Asc
Virginia Mason Medical Center
$6,724.00Published rateSurgical Center At Millburn, LLC
Surgical Center At Millburn LLC
$3,448.00Published rateSouthpoint Surgery Center LLC
$2,700.00Published rateUpper Cumberland Physicians Surgery Center LLC
$1,500.00Published rateAbisai Negron
Deaconess Hospital Inc
$502.29Published rate
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See a sample payer proposalCPT 26531 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 26531 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 26531 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 |
|---|---|---|
| 26530-CPT | Moderate | Arthroplasty M-P Joint |
| 26531-CPT | Moderate | Arthroplst Metacarpophalang Joint; W/ Prosthet Implnt Ea, Arthroplasty Metacarpophalangeal Joint; With Prosthetic Implant Each |
| 26535-CPT | Moderate | Arthroplasty I-P Joint |
| 26536-CPT | High | Arthroplst Interphalang Joint; W/ Prosthet Implnt Ea Joi, Arthroplasty Interphalangeal Joint; With Prosthetic Implant Each Joi |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 26531. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 26531 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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