CPT 61026 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 Nervous System |
| Common Place of Service | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • AG - Primary physician • UA |
| Complexity Level | Low |
National average reimbursement for CPT 61026 by major payers:
$164.31
$156.32
$159.09
$187.54
| 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 61026 | ||||||
United | 61026 | $2172.00 | 1902218456 - TEXAS ENDOSCOPY CENTERS, LLC, TEXAS ENDOSCOPY AT INDEPENDENCE MEDICAL VILLAGE | 470985876 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61026 | $893.00 | 1629508387 - WELLINGTON ENDOSCOPY CENTER LLC | 813254698 - (FL) WELLINGTON ENDOSCOPY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61026 | $700.00 | 1275510141 - NEOSPINE PUYALLUP SPINE CENTER, LLC, MICROSURGICAL SPINE CENTER | 203395071 - (WA) NEOSPINE PUYALLUP SPINE CENTER LLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61026 | $953.00 | 1194724690 - ENDOSCOPY CENTER OF DAYTON NORTH LLC | 311703317 - (OH) ENDOSCOPY CENTER OF DAYTON NORTH LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61026 | $1036.00 | 1336148360 - BOULDER COMMUNITY MUSCULOSKELETAL SURGERY CENTER, LLC, BOULDER SURGERY CENTER | 201391702 - (CO) BOULDER COMMUNITY MUSCULOSKELETAL SURGERY CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61026 | $953.00 | 1275870537 - GCSA AMBULATORY SURGERY CENTER, LLC | 611699459 - (TX) GCSA AMBULATORY SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61026 | $109.00 | 1992845283 - CHESAPEAKE AMBULATORY SURGERY CENTER | 522240631 - (MD) CHESAPEAKE AMBULATORY SURGERY CENTER | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61026 | $374.00 | 1285340430 - CORRIDOR SURGERY CENTER | 832869527 - (IA) CORRIDOR SURGERY CENTER | IA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61026 | $410.00 | 1407820962 - WINTER HAVEN SEBRING FL OPHTHALMOLOGY ASC LLC, EYE SURGERY & LASER CENTER | 743072437 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61026 | $775.00 | 1538389812 - IRONBOUND ENDO SURGICAL CENTER, INC. | 223651393 | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61026 | $450.00 | 1962869826 - ENDOTECH, LLC | 472926864 - (AZ) ENDOTECH LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61026 | $550.00 | 1215993100 - GAINESVILLE SURG CTR LP | 621600268 - (GA) GAINESVILLE SURG CTR LP | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61026 | $1955.00 | 1992721591 - DAY SURGERY CENTER OF NORTH TEXAS LTD | 260308454 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61026 | $967.00 | 1003004482 - SUMMIT AMBULATORY SURGICAL CENTER, LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 61026 | $1850.00 | 1033468400 - WHITE FENCE SURGICAL SUITES, LLC | 460796333 - (OH) WHITE FENCE SURGICAL SUITES LLC | 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 61026 vs. Other Surgical Procedures on the Nervous System Codes
The CPT 61026 code is part of the Surgery services used for Surgical Procedures on the Nervous 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 61026 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 |
|---|---|---|
| 61020-CPT | Low | Ventricular Puncture Through Previous Burr Hole, Fontanelle, Suture, Or Implanted Ventricular Catheter/Reservoir; Without Injection |
| 61026-CPT | Low | Ventricular Puncture Through Previous Burr Hole, Fontanelle, Suture, Or Implanted Ventricular Catheter/Reservoir; With Injection Of Medication Or Other Substance For Diagnosis Or Treatment |
| 61105-CPT | Moderate | Puncture Ventric W Twist Drill |
| 61150-CPT | High | Burr Hole/Trep;Drain Brain Absc/Cys |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 61026. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 61026 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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