CPT 26742 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 • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • F4 - Left hand, fifth digit • F9 - Right hand, fifth digit |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 26742 |
National average reimbursement for CPT 26742 by major payers:
$520.77
$493.54
$520.35
$632.36
| 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 26742 | ||||||
United | 26742 | $641.00 | 1780935528 - QUEENS ENDOSCOPY ASC, LLC | 274189294 | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26742 | $1096.00 | 1245749258 - FOCUS HAND SURGICENTER LLC, FOCUS HAND AND ARM SURGERY CENTER | 822523843 | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26742 | $124.00 | 1023010311 - BLUE RIDGE SURGICAL CENTER, LLC | 141854493 - (MO) BLUE RIDGE SURGICAL CENTER LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26742 | $142.00 | 1801343496 - TRADITION SURGERY CENTER, LLC | 364837780 - (FL) TRADITION SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26742 | $157.00 | 1386028439 - JOHNSTON MEMORIAL HOSPITAL, INC, JOHNSTON MEMORIAL SURGERY CENTER | 540544705 - JOHNSTON MEMORIAL HOSPITAL INC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26742 | $198.00 | 1265851034 - HANCOCK PARK SURGERY CENTER, LLC | 465306378 - (CA) HANCOCK PARK SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26742 | $301.00 | 1588302707 - ALLINA HEALTH SURGERY CENTER- VADNAIS HEIGHTS LLC | 882406421 - (MN) ALLINA HEALTH SURGERY CENTER VADNAIS HEIGHTS LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26742 | $574.00 | 1376779561 - SURGICARE OF MIRAMAR LLC | 208552194 - (FL) SURGICARE OF MIRAMAR LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26742 | $574.00 | 1821036138 - GAMMA SURGERY CENTER LLC | 270128900 - (PA) GAMMA SURGERY CENTER LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26742 | $206.00 | 1962959296 - RUSH-COPLEY SURGICENTER, LLC, CASTLE SURGICENTER | 384012268 | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26742 | $911.00 | 1740918887 - ORTHOMIDWEST SURGERY CENTER BELOIT, LLC | 881260648 - (WI) ORTHOMIDWEST SURGERY CENTER BELOIT LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26742 | $450.00 | 1861648404 - MUSKEGON SC, LLC, MUSKEGON SURGERY CENTER | 203244346 - (MI) MUSKEGON SC, LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26742 | $1543.00 | 1023113701 - SURGICAL CENTER OF CONNECTICUT LLC | 61552689 - (CT) SURGICAL CENTER OF CONNECTICUT | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26742 | $350.00 | 1780206292 - GREECE ASC, LLC, CORNERSTONE SURGERY CENTER | 824108616 - (NY) GREECE ASC LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26742 | $2830.00 | 1881662856 - SILICON VALLEY SURGERY CENTER, LP | 770495522 - (CA) SILICON VALLEY SURGERY CENTER, L.P. | 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 |
Want to see your competitors' rates?
Start your trial today to unlock complete access to provider rates and fee schedules in your area.
Here's what you can do with PayerPrice
Renegotiate your managed care contracts
Benchmark your current rates against market averages to identify opportunities for rate optimization.
Prospect for new business using fee schedules
Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.
Integrate real-time payer data into your workflows
Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.
PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.
CPT 26742 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 26742 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 26742 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 |
|---|---|---|
| 26727-CPT | Moderate | Percutaneous Skeletal Fixation Of Unstable Phalangeal Shaft Fracture, Proximal Or Middle Phalanx, Finger Or Thumb, With Manipulation, Each |
| 26735-CPT | Moderate | Open Treatment Of Phalangeal Shaft Fracture, Proximal Or Middle Phalanx, Finger Or Thumb, Includes Internal Fixation, When Performed, Each |
| 26740-CPT | Moderate | Closed Treatment Of Articular Fracture, Involving Metacarpophalangeal Or Interphalangeal Joint; Without Manipulation, Each |
| 26742-CPT | Moderate | Tx Clos Articular Fx W Meta/Prox.Ip Jnt; |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 26742. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 26742 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.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 26742) and we'll show you how you compare in 15 minutes or less.