CPT 26952 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 • F2 - Left hand, third digit • F1 - Left hand, second digit |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 26952 |
National average reimbursement for CPT 26952 by major payers:
$976.06
$884.47
$925.63
$1,139.19
| 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 26952 | ||||||
United | 26952 | $569.00 | 1669427043 - VANCOUVER EYE CARE PS | 910913651 - (WA) VANCOUVER EYE CARE, P.S. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26952 | $2775.00 | 1821614710 - BAYCARE AURORA KAUKAUNA SURGERY CENTER LLC, KAUKAUNA SURGERY CENTER | 851420464 - (WI) BAYCARE AURORA KAUKAUNA SURGERY CENTER LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26952 | $653.00 | 1255607628 - MINIMALLY INVASIVE NEUROSPINE AND PAIN INSTITUTE, PC, ALLSPINE SURGERY CENTER | 274395849 - (GA) MINIMALLY INVASIVE NEUROSPINE AND PAIN INSTITUTE PC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26952 | $1245.00 | 1508934373 - CENTERS FOR PAIN SOLUTIONS,LLC | 20522938 - (NH) CENTERS FOR PAIN SOLUTIONSLLC | NH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26952 | $1875.00 | 1649922485 - NORTHERN LAKES SURGERY CENTER LLC | 874431494 - (MN) NORTHERN LAKES SURGERY CENTER LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26952 | $935.00 | 1801859970 - LOS GATOS SURGICAL CENTER, A CALIFORNIA LIMITED PARTNERSHIP | 942909203 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26952 | $1276.00 | 1558794081 - SURGERY CENTER OF SCOTTSDALE, LLC | 731553441 - (AZ) SURGERY CENTER OF SCOTTSDALE LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26952 | $1250.00 | 1467499293 - ST CLOUD MN OPHTHALMOLOGY ASC LLC, ST. CLOUD CENTER FOR OPHTHALMIC SURGERY | 203853072 - (MN) ST CLOUD MN OPHTHALMOLOGY ASC LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26952 | $993.00 | 1578003208 - MINNESOTA EYE LASER & SURGERY CENTERS, LLC | 460505033 - (MN) MINNESOTA EYE LASER SURGERY CENTERS LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26952 | $1050.00 | 1346205481 - BLOOMINGTON EYE INSTITUTE LLC | 371361486 - (IL) BLOOMINGTON EYE INSTITUTE LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26952 | $1152.00 | 1629703236 - NORTH CYPRESS SURGICENTER, LLC, NORTH CYPRESS SURGERY CENTER | 851383722 - (TX) NORTH CYPRESS SURGICENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26952 | $950.00 | 1811076623 - SPARTANBURG SURGERY CENTER, LLC | 570953005 - (SC) SPARTANBURG SURGERY CENTER LLC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26952 | $1000.00 | 1043236664 - ST. MARY'S AMBULATORY SURGERY CENTER, LLC | 593812095 - (VA) ST MARYS AMBULATORY SURGERY CENTER LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26952 | $644.00 | 1639242506 - RENAL INTERVENTION CENTER, LLC | 371387622 - (IL) RENAL INTERVENTION CENTER LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 26952 | $935.00 | 1386858595 - ALDERWOOD SURGERY CENTER LLC | 204979154 - (WA) ALDERWOOD SURGICAL CENTER | WA | 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 26952 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 26952 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 26952 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 |
| 26910-CPT | Moderate | Amputation Metacarpal W Finger/Thumb,1,W |
| 26951-CPT | Moderate | Amputation, Finger Or Thumb, Primary Or Secondary, Any Joint Or Phalanx, Single, Including Neurectomies; With Direct Closure |
| 26952-CPT | Moderate | Amputation, Finger Or Thumb, Primary Or Secondary, Any Joint Or Phalanx, Single, Including Neurectomies; With Local Advancement Flaps (V-Y, Hood) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 26952. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 26952 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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