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 |
| Medicare Fee Schedule | View Medicare rates for 26725 |
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 | $719.00 | 1659443042 - HALLANDALE OUTPATIENT SURGICAL CENTER,LTD | 200244303 - (FL) HALLANDALE OUTPATIENT SURGICAL CENTERLTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26725 | $450.00 | 1992259337 - ADVOCATE CONDELL AMBULATORY SURGERY CENTER, LLC | 475337115 - (IL) ADVOCATE CONDELL AMBULATORY SURGERY CENTER LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26725 | $490.00 | 1386721249 - ALLIED PHYSICIANS SURGERY CENTER, LLC | 352057452 - (IN) ALLIED PHYSICIANS SURGERY CENTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26725 | $1446.00 | 1023420577 - TEXAS ENDOSCOPY CENTERS, LLC, TEXAS ENDOSCOPY | 470985876 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26725 | $89.00 | 1083837926 - HERITAGE EYE SURGERY CENTER, LLC, PRECISION VISION SURGERY CENTER | 731097247 - (OK) EDWARD D. GLINSKI, D.O. & ACCOCIATES, INC. | OK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26725 | $50.00 | 1639618036 - PRESENCE LAKESHORE GASTROENTEROLOGY, LLC | 811750563 - (IL) PRESENCE LAKESHORE GASTROENTEROLOGY LLC DBA DES PLAINES ENDOSCOPY CENT | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26725 | $100.00 | 1912971326 - ADVANCED SURGERY CENTER, LLC | 351991340 - (IN) ADVANCED SURGERY CENTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26725 | $541.00 | 1316900830 - BAYONET POINT SURGERY CENTER LTD | 200670560 - (FL) BAYONET POINT SURGERY CENTER LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26725 | $114.00 | 1730113325 - DHA ENDOSCOPY LLC | 43551976 | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26725 | $166.00 | 1538647474 - PALOS HEALTH SURGERY CENTER, LLC | 352634975 - (IL) PALOS HEALTH SURGERY CENTER LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26725 | $270.98 | 1700393683 - MELISSA HARMON | 350593390 - DEACONESS HOSPITAL INC | KY | Family Nurse Practitioner (363LF0000X) |
United | 26725 | $750.00 | 1366647968 - NORTH POINTE SURGERY CENTER, LP | 204435545 | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26725 | $91.00 | 1508209743 - CRESCENT VIEW SURGERY CENTER, LLC | 462070269 | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26725 | $275.00 | 1871596114 - NORTHERN ARIZONA SURGICENTER, LLC | 860747413 - (AZ) NORTHERN ARIZONA SURGICENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26725 | $122.00 | 1366032617 - EMERSON ENDOSCOPY AND DIGESTIVE HEALTH CENTER, LLC | 843673604 - (MA) EMERSON ENDOSCOPY AND DIGESTIVE HEALTH CENTER LLC | MA | 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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