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See a sample rate comparisonCPT 99026 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.
Hospital Mandated On Call Service; In-Hospital, Each Hour
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Special Services, Procedures and Reports |
| Common Place of Service | 11 - Office 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital |
| Common Modifiers | None GP - Services delivered under an outpatient physical therapy plan of care 25 - Significant, separately identifiable E/M service same day |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 99026 |
National average reimbursement for CPT 99026 by major payers:
$56.25
$56.69
$41.96
$110.65
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CPT 99026
5 of 25 sample ratesHigher to lower in this preview
Crosbyton Clinic Hospital
$1,272.00Published rateAll Ways Homecare Inc
$55.00Published rateDa Pediatric Rehabilitation
$55.00Published rateDa Pediatric Rehabilitation
$40.00Published rateRestorative Health Rehabilitation Inc
$35.00Published rate
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See a sample payer proposalCPT 99026 vs. Other Special Services, Procedures and Reports Codes
The CPT 99026 code is part of the Medicine Services and Procedures services used for Special Services, Procedures and Reports. 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 99026 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 |
|---|---|---|
| 99024-CPT | Low | Postop Follow Up Visit, Postoperative Follow Up Visit Normally Included In The Surgical Package To Indicate That An Evaluation And Management Service Was Performed During A Postoperative Period For A Reason S Related To The Original Procedure |
| 99026-CPT | Low | Hospital Mandated On Call Service; In-Hospital, Each Hour |
| 99027-CPT | Low | Hospital Mandated On Call Service; Out-Of-Hospital, Each Hour |
| 99050-CPT | Low | Medical Services After Hrs, Services Provided In The Office At Times Other Than Regularly Scheduled Office Hours Or Days When The Office Is Normally Closed Eg Holidays Saturday Or Sunday In Addition To Basic Service |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99026. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99026 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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