CPT 26686 Fee Schedule
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.
| 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 • RT - Right side of body • F9 - Right hand, fifth digit |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 26686 |
National average reimbursement for CPT 26686 by major payers:
$837.03
$838.83
$850.21
$1,050.68
| 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 26686 | ||||||
United | 26686 | $2800.00 | 1669405684 - PACIFICOAST AMBULATORY SURGICENTER, LLC., PACIFIC COAST AMBULATORY SURGICENTER | 474003673 - (CA) PACIFICOAST AMBULATORY SURGICENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26686 | $2845.00 | 1609896539 - CEDAR HILLS AMBULATORY SURGERY CENTER LLC, CEDAR HILLS SURGERY CENTER | 680580628 - (OR) CEDAR HILLS AMBULATORY SURGERY CENTER LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26686 | $1339.00 | 1073818654 - ROYAL OAK SURGICAL CENTER, LLC, ROYAL OAK SURGICAL CENTER PLLC | 320323562 - (MI) ROYAL OAK SURGICAL CENTER LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26686 | $6492.00 | 1972869881 - ADVANCED SURGERY CENTER OF BETHESDA, LLC | 454376136 - (MD) ASC BETHESDA | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26686 | $3600.00 | 1457820466 - CHINO PREMIER SURGERY CENTER LIMITED PARTNERSHIP | 822652791 - (CA) CHINO PREMIER SURGERY CENTER LIMITED PARTNERSHIP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26686 | $4763.00 | 1194083824 - PROVIDENCE FACEY MEDICAL FOUNDATION, FACEY ENDOSCOPY CENTER | 954322584 - (CA) PROVIDENCE FACEY MEDICAL FOUNDATION | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26686 | $6973.00 | 1407591902 - AUSTIN GI SURGICENTER, LLC, AUSTIN ENDOSCOPY CENTER | 301073754 - (TX) AUSTIN GI SURGICENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26686 | $6365.00 | 1942851639 - NORTHERN MICHIGAN SURGICAL SUITES, LLC | 830670803 - (MI) NORTHERN MICHIGAN SURGICAL SUITES, LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26686 | $3394.00 | 1417903899 - JUPITER OUTPATIENT SURGERY CENTER LLC | 650925020 - (FL) JUPITER OUTPATIENT SURGERY CENTER, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26686 | $1645.00 | 1538579313 - EYE SURGERY CENTER OF NORTH DALLAS | 462356251 - (TX) EYE SURGERY CENTER OF NORTH DALLAS | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26686 | $6365.00 | 1588854772 - ALABAMA DIGESTIVE HEALTH ENDOSCOPY CENTER, LLC | 201243484 - (AL) ALABAMA DIGESTIVE HEALTH | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26686 | $5500.00 | 1962953018 - THE SURGERY CENTER AT TGH BRANDON HEALTHPLEX LLC | 611795393 - (FL) THE SURGERY CENTER AT TGH BRANDON HEALTHPLEX LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26686 | $1084.43 | 1780116038 - ARHAM ZAVERY | 350593390 - DEACONESS HOSPITAL INC | KY | Internal Medicine Physician (207R00000X) |
United | 26686 | $1088.00 | 1376692129 - STUART CARDON, CASCADE FOOT AND ANKLE PLLC | 205179809 - (WA) STUART CARDON DBA CASCADE FOOT & | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26686 | $1796.00 | 1851407373 - RIVERSIDE AMBULATORY SURGERY CENTER, LLC | 320082320 - (IL) RIVERSIDE AMBULATORY SURGERY CENTER, LLC | IL | 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 26686 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 26686 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 26686 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 |
|---|---|---|
| 26641-CPT | Moderate | Close Carpometacarpal Dis W Manip |
| 26645-CPT | Moderate | Red Fx-Bennett |
| 26665-CPT | Moderate | Open Treatment Of Carpometacarpal Fracture Dislocation, Thumb (Bennett Fracture), Includes Internal Fixation, When Performed |
| 26686-CPT | Moderate | Open Treatment Of Closed Or Open Carpometacarpal Dislocation, Other Than Bennett Fracture; Complex, Multiple Or Del |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 26686. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 26686 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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