CPT 26541 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address high-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 • F5 - Right hand, thumb • RT - Right side of body |
| Complexity Level | High |
National average reimbursement for CPT 26541 by major payers:
$1,135.96
$1,095.47
$1,144.90
$1,398.44
| 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 26541 | ||||||
United | 26541 | $2184.00 | 1689736118 - VOA AMBULATORY SURGERY CENTER | 582351035 - (GA) VOA AMBULATORY SURGERY CENTER | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26541 | $3500.00 | 1831551266 - INOV8 SURGICAL AT MEMORIAL CITY, INOV8 SURGICAL | 475640889 - (TX) INOV8 SURGICAL AT MEMORIAL CITY | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26541 | $2039.00 | 1346292372 - SURGERY CENTER PARTNERS. LLC, TIMBERLAKE SURGERY CENTER | 421580803 - (MO) SURGERY CENTER PARTNERS LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26541 | $3500.00 | 1184714214 - GAINESVILLE ENDOSCOPY CENTER, LLC | 10750801 - (GA) GAINESVILLE ENDOSCOPY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26541 | $6904.00 | 1598096802 - MEMORIAL HERMANN SURGERY CENTER MEMORIAL CITY LLC, MEMORIAL HERMANN MEMORIAL VILLAGE SURGERY CENTER | 264276930 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26541 | $2056.00 | 1750582797 - BAY AREA LASER SURGERY CENTER, A MEDICAL CORPORATION | 208712646 - (CA) BAY AREA LASER SURGERY CENTER A MEDICAL CORPORATION | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26541 | $901.00 | 1033113402 - NORTHWEST FLORIDA SURGICAL CENTER, LLC, NORTH FLORIDA SURGERY CENTER | 593081991 - (FL) NORTHWEST FLORIDA SURGICAL CENTER | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26541 | $1750.00 | 1427577840 - DIALYSIS ACCESS CENTER OF CINCINNATI, INC. | 815023998 - (OH) DIALYSIS ACCESS CENTER OF CINCINNATI INC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26541 | $1109.00 | 1326494147 - CENTER FOR SPINE & PAIN MEDICINE PC, CSPM GAINESVILLE ASC | 341976829 - CENTER FOR SPINE AND PAIN MEDICI | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26541 | $3350.00 | 1922028265 - ATLANTIC GASTRO SURGICENTER, LLC, T/A ACCESS | 222280343 - (NJ) ATLANTIC GASTROENTEROLOGY ASSOCIATES, P.A. | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26541 | $2771.00 | 1891745956 - NORTH SUBURBAN SPINE CENTER LP, NORTH METRO SURGERY CENTER | 571231282 | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26541 | $2700.00 | 1225439250 - ADVANCED SURGERY CENTER OF SAN ANTONIO, LLC | 465742281 - (TX) ADVANCED SURGERY CENTER OF SAN ANTONIO, LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26541 | $2435.00 | 1437250248 - GEORGIA SURGICAL CENTER ON PEACHTREE, LLC | 582394271 - (GA) GEORGIA SURGICAL CENTER ON PEACHTREE LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26541 | $1342.00 | 1629404918 - CENTRAL ARKANSAS SURGERY CENTER, LLC | 462585307 - (AR) CENTRAL ARKANSAS SURGERY CENTER LLC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26541 | $3623.00 | 1659517019 - SURGERY CENTER OF PEMBROKE PINES, LLC | 263364068 - (FL) SURGERY CENTER OF PEMBROKE | FL | 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 26541 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 26541 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 26541 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 |
|---|---|---|
| 26535-CPT | Moderate | Arthroplasty I-P Joint |
| 26536-CPT | High | Arthroplasty I-P W Prosth Implant |
| 26540-CPT | Moderate | Reconstruct Collat Lig M-P Joint |
| 26541-CPT | High | Reconstruction, Collateral Ligament, Metacarpophalangeal Joint, Single; With Tendon Or Fascial Graft (Includes Obtaining Graft) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 26541. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 26541 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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