CPT 26725 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 | • 23 - Emergency Room • 11 - Office |
| Common Modifiers | • None • 54 - Surgical Care Only • F4 - Left hand, fifth digit |
| Complexity Level | Moderate |
National average reimbursement for CPT 26725 by major payers:
$452.33
$449.58
$493.53
$578.92
| 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 26725 | ||||||
United | 26725 | $2965.00 | 1679523351 - SURGERY CENTER OF PORT CHARLOTTE LTD | 201327093 - (FL) SURGERY CENTER OF PORT CHARLOTTE LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26725 | $574.00 | 1912265653 - BRASELTON ENDOSCOPY CENTER, LLC | 453369410 - (GA) BRASELTON ENDOSCOPY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26725 | $63.00 | 1104272780 - ENT OF SOUTH GEORGIA SURGERY CENTER LLC | 474050916 - (GA) ENT OF SOUTH GEORGIA SURGERY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26725 | $318.00 | 1225439250 - ADVANCED SURGERY CENTER OF SAN ANTONIO, LLC | 465742281 - (TX) ADVANCED SURGERY CENTER OF SAN ANTONIO, LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26725 | $300.00 | 1750709358 - EASTSIDE MEDICAL GROUP, LLC | 451231126 - (WA) EASTSIDE MEDICAL GROUP | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26725 | $2347.00 | 1548844400 - SAINT LUKES SOUTH PAIN MANAGEMENT CENTER LLC | 863451115 - (KS) SAINT LUKES SOUTH PAIN MANAGEMENT CENTER LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26725 | $574.00 | 1114196151 - SUMMIT AMBULATORY SURGICAL CENTER LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26725 | $383.00 | 1740479476 - MEADOW LAKE SURGERY CENTER INC | 204804837 - (ID) MEADOW LAKE SURGERY CENTER INC | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26725 | $531.00 | 1538126362 - WINTER HAVEN AMBULATORY SURGICAL CENTER LLC | 593659906 - (FL) WINTER HAVEN AMBULATORY SURGICAL CENTER, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26725 | $88.00 | 1982744231 - SOUTHLAND ENDOSCOPY CENTER, SOUTHLAND ENDOSCOPY CENTER | 330607952 - (CA) SOUTHLAND ENDOSCOPY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26725 | $97.00 | 1558618116 - TAVARES SURGERY LLC | 300728155 - (FL) TAVARES SURGERY LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26725 | $114.00 | 1457490872 - HSC SURGICAL ASSOCIATES, FAIRFIELD ENDOSCOPY CENTER | 311386408 - (OH) HSC SURGICAL ASSOCIATES OF CINCINNATI, LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26725 | $130.00 | 1639203888 - VALLEY MEDICAL GROUP, P.C., VALLEY MEDICAL GROUP AMBULATORY SURGERY & PROCEDURES CENTER | 42945394 - (MA) VALLEY MEDICAL GROUP, P.C. | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26725 | $125.00 | 1043560295 - CENTENNIAL SPECIALTY SURGERY CENTER INC | 454699837 - (NV) CENTENNIAL SPECIALTY SURGERY CENTER INC | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26725 | $129.00 | 1346287232 - MODESTO SURGERY CENTER | 770394007 | CA | 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 26725 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 26725 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 26725 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 |
|---|---|---|
| 26700-CPT | Moderate | Close Metacarpophalange Dis Wo Anes |
| 26705-CPT | Moderate | Tx Cl.Metacarpophal.Disloc,Sgle,W Manip; |
| 26706-CPT | Moderate | Perc Fix Metacarpophalange W Manip |
| 26725-CPT | Moderate | Closed Treatment Of Phalangeal Shaft Fracture, Proximal Or Middle Phalanx, Finger Or Thumb; With Manipulation, With Or Without Skin Or Skeletal Traction, Each |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 26725. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 26725 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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