CPT 26863 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 • F7 - Right hand, third digit • F2 - Left hand, third digit |
| Complexity Level | Moderate |
National average reimbursement for CPT 26863 by major payers:
$324.24
$315.26
$311.78
$381.59
| 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 26863 | ||||||
United | 26863 | $574.00 | 1568867075 - POTOMAC VIEW SURGERY CENTER, LLC | 471352116 - (MD) POTOMAC VIEW SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26863 | $100.00 | 1750333746 - NORTH PINELLAS SURGERY CENTER LLC | 593759228 - (FL) NORTH PINELLAS SURGERY CENTER, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26863 | $150.00 | 1124587548 - GATEWAY SURGICAL CENTER, LLC | 830521568 - (TX) GATEWAY SURGICAL CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26863 | $97.00 | 1336231059 - CENTINELA VALLEY ENDOSCOPY CENTER INC. | 200244220 - (CA) CENTINELA VALLEY ENDOSCOPY CENTER INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26863 | $136.00 | 1053407353 - ROC-ASC, LLP | 200932645 - (TX) ROCASC LLP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26863 | $200.00 | 1235363987 - CORONADO SURGERY CENTER, LLC | 274700340 | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26863 | $67.00 | 1962031807 - CVP SURGERY CENTER IVY POINTE, LLC | 311473421 - CINCINNATI EYE INSTITUTE | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26863 | $456.00 | 1376641670 - AMBULATORY SURGERY CENTER OF GREATER NEW YORK, LLC | 133418924 - (NY) AMBULATORY SURGERY CENTER OF GREATER NEW YORK, LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26863 | $357.00 | 1447788120 - NORCAL ORTHOPEDIC SURGERY CENTER, LLC | 821046949 - (CA) NORCAL ORTHOPEDIC SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26863 | $400.00 | 1518300102 - SPRINGFIELD SURGERY CENTER, LLC | 461041413 - (NJ) SPRINGFIELD SURGERY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26863 | $566.00 | 1265534556 - SOUTH FLORIDA AMBULATORY SURGICAL CENTER LLC | 651093026 - (FL) SOUTH FLORIDA AMBULATORY SURGI | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26863 | $839.00 | 1548791593 - BRIDGEWATER AMBULATORY SURGERY CENTER, LLC | 820860675 - (NJ) BRIDGEWATER AMBULATORY SURGERY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26863 | $300.00 | 1649416231 - CLINTON PARTNERS, LLC, SURGERY CENTER OF CLINTON TOWNSHIP | 202236024 | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26863 | $327.00 | 1033190566 - NORTHERN INDIANA AMBULATORY SURGERY CENTER, RIVERPOINTE SURGERY CENTER | 351994079 - NORTHERN INDIANA AMBULATORY SURGERY CENTER, LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26863 | $150.00 | 1427577840 - DIALYSIS ACCESS CENTER OF CINCINNATI, INC. | 815023998 - (OH) DIALYSIS ACCESS CENTER OF CINCINNATI INC | OH | 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 26863 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 26863 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 26863 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 26863. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 26863 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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