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See a sample rate comparisonCPT 26535 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 I-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 F2 - Left hand, third digit |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 26535 |
| Medicaid Fee Schedule | View Medicaid rates for 26535 |
National average reimbursement for CPT 26535 by major payers:
$603.95
$565.57
$592.23
$712.24
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CPT 26535
5 of 25 sample ratesHigher to lower in this preview
Deaconess Hospital, Inc, <Unavail>
Deaconess Hospital Inc
$11,927.00Published rateBountiful Surgery Center, LLC
$3,705.00Published rateQuality Care Surgery Center, LLC
Quality Care Surgery Center LLC
$2,465.00Published rateLowery A. Woodall Outpatient Surgery Facility, LLC
$1,302.00Published rateDiane Hancock
Deaconess Hospital Inc
$345.76Published rate
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See a sample payer proposalCPT 26535 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 26535 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 26535 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 26535. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 26535 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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