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See a sample rate comparisonCPT 26863 Fee Schedule
Last Verified: October 2026
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.
Fuse Graft Added Joint, 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
| 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 |
| Medicare Fee Schedule | View Medicare rates for 26863 |
| Medicaid Fee Schedule | View Medicaid rates for 26863 |
National average reimbursement for CPT 26863 by major payers:
$324.24
$315.26
$311.78
$374.88
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CPT 26863
5 of 25 sample ratesHigher to lower in this preview
Henry Ford Medical Center Fairlane, Henry Ford Health System
Henry Ford Health System
$1,735.00Published rateNorth Shore Same Day Surgery LLC, North Shore Surgical Center
North Shore Same Day Surgery LLC
$574.00Published rateLoyola Ambulatory Surgery Center At Oakbrook Lp
$500.00Published ratePisa Asc Holdco LLC, Pain Institute Of Southern Arizona Procedure Center
Pisa Asc Holdco LLC
$230.00Published rateCentinela Valley Endoscopy Center Inc.
Centinela Valley Endoscopy Center Inc
$97.00Published rate
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See a sample payer proposalCPT 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 | Fuse Bones Of Finger Joint, Surgery To Join Together Two Or More Bones Of Finger Joint. The Procedure Is Done To Relieve Pain By Eliminating Motion Between The Bones. |
| 26861-CPT | Low | Fusion Of Finger Jnt Add On, Arthrodesis Interphalangeal Joint With Or Without Internal Fixation Each Additional Interphalangeal Joint List Separately In Addition To Code For Primary Procedure |
| 26862-CPT | High | Fuse Bones Of Finger Joint, Surgery To Join Together Two Or More Bones Of Finger Joint. The Procedure Is Done To Relieve Pain By Eliminating Motion Between The Bones. |
| 26863-CPT | Moderate | Fuse Graft Added Joint, 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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