CPT 26860 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 • F6 - Right hand, second digit • F1 - Left hand, second digit |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 26860 |
National average reimbursement for CPT 26860 by major payers:
$782.02
$775.66
$838.34
$1,015.11
| 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 26860 | ||||||
United | 26860 | $1226.00 | 1073030532 - AKDHC SURGERY CENTER, LLC | 753052504 | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26860 | $445.27 | 1235606641 - ERIN NESTER | 350593390 - DEACONESS HOSPITAL INC | IN | Nurse Practitioner (363L00000X) |
United | 26860 | $3347.00 | 1881905792 - SURGCENTER PINELLAS, LLC | 271372259 - (FL) SURGCENTER PINELLAS, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26860 | $1800.00 | 1053366930 - ADVANCED SURGERY CENTER, LLC | 342045695 - (NE) ADVANCED SURGERY CENTER, LLC | NE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26860 | $624.00 | 1730369802 - SHORELINE SURGERY CENTER LLP, CHRISTUS SPOHN-SURGICARE OF CORPUS CHRISTI | 204911604 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26860 | $624.00 | 1770541708 - SUTTER ALHAMBRA SURGERY CENTER LP, HEALTHSOUTH SURGERY CENTER OF ALHAMBRA, L.P. | 631221949 - (CA) SUTTER ALHAMBRA SURGERY CENTER LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26860 | $7825.00 | 1659519684 - SOUTH CAMPUS SURGERY CENTER | 352038072 - (IN) SOUTH CAMPUS SURGERY CENTER | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26860 | $969.14 | 1700346830 - CAMERON WALLER | 350593390 - DEACONESS HOSPITAL INC | IN | Anesthesiology Physician (207L00000X) |
United | 26860 | $1987.00 | 1366864514 - GREAT SOUTH BAY ENDOSCOPY CENTER, LLC | 463055867 - (NY) GREAT SOUTH BAY ENDOSCOPY CENTER LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26860 | $1262.00 | 1255314662 - MAZZOCCO AMBULATORY SURGICAL CENTER | 954505995 - (CA) MAZZOCCO AMBULATORY SURGICAL CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26860 | $2791.00 | 1215040464 - DEERPATH AMBULATORY SURGICAL CENTER, LLC, DEERPATH ORTHOPEDIC SURGICAL CENTER | 800033465 - (IL) DEERPATH AMBULATORY SURGICAL CENTER, LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26860 | $3623.00 | 1245263292 - CHATTANOOGA PAIN MANAGEMENT CENTER LLC, CHATTANOOGA PAIN SURGERY CENTER | 320121593 - (TN) CHATTANOOGA PAIN MANAGEMENT | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26860 | $965.00 | 1295851137 - PHYSICIANS SURGERY CENTER LLC | 200435814 - (AR) PHYSICIANS SURGERY CENTER LLC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26860 | $949.00 | 1205809795 - OAKHURST ENDOSCOPY ASC LLC, OCEAN SURGICAL PAVILION, INC. | 223182653 | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26860 | $445.27 | 1790275766 - SPENCER GREENWOOD | 350593390 - DEACONESS HOSPITAL INC | IN | Certified Registered Nurse Anesthetist (367500000X) |
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 26860 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 26860 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 26860 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 |
|---|---|---|
| 26860-CPT | Moderate | Arthrodesis,Interphalangeal Joint,W/Wo I |
| 26861-CPT | Low | Arthrodesis, Interphalangeal Joint, With Or Without Internal Fixation; Each Additional Interphalangeal Joint (List Separately In Addition To Code For Primary Procedure) |
| 26862-CPT | High | Arthrodesis,Interphalan.Joint,W/Wo Fix;W |
| 26863-CPT | Moderate | Arthrodesis, Interphalangeal Joint, With Or Without Internal Fixation; With Autograft (Includes Obtaining Graft), Each Additional Joint (List Separately In Addition To Code For Primary Procedure) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 26860. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 26860 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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