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See a sample rate comparisonCPT 26992 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
Ncision Bone Cortex Pelvis &/Or Hip Joint (Eg Osteomyeli, Incision Bone Cortex Pelvis And/Or Hip Joint (Eg Osteomyelitis Or B
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital |
| Common Modifiers | None RT - Right side of body LT - Left side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 26992 |
| Medicaid Fee Schedule | View Medicaid rates for 26992 |
National average reimbursement for CPT 26992 by major payers:
$1,408.47
$1,323.91
$1,348.73
$1,629.47
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CPT 26992
5 of 25 sample ratesHigher to lower in this preview
Pinnacle Surgery Center, Inc
Pinnacle Surgery Center Inc
$15,000.00Published rateCoral Ridge Outpatient Center LLC, Coral Ridge Outpatient Center
Coral Ridge Outpatient Center, LLC
$5,433.00Published rateWiregrass Ranch Asc Holdings, Wiregrass Ranch Ambulatory Surgery Center
Wiregrass Ranch Asc Holdings
$3,600.00Published rateGsi Asc, LLC
Gsi Asc LLC
$1,700.00Published rateLillian Silva
Deaconess Hospital Inc
$776.03Published rate
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See a sample payer proposalCPT 26992 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 26992 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 26992 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 |
|---|---|---|
| 26990-CPT | Moderate | Drain Pelvis Or Hip Infection, Surgery To Cut Open And Drain A Deep Infection Or Collection Of Blood (Hematoma) From The Pelvis Or Hip. |
| 26991-CPT | Moderate | Drain Pelvis Or Hip Infection, Surgery To Cut Open And Drain A Deep Infection Or Collection Of Blood (Hematoma) From The Pelvis Or Hip. |
| 26992-CPT | High | Ncision Bone Cortex Pelvis &/Or Hip Joint (Eg Osteomyeli, Incision Bone Cortex Pelvis And/Or Hip Joint (Eg Osteomyelitis Or B |
| 27000-CPT | Moderate | Tenotomy Adductor Hip Subcut Closed |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 26992. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 26992 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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