HCPCS T1026 Fee Schedule
Last Updated: August 2025
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.
| Key Fact | Detail |
|---|---|
| Service Type | • National Codes Established for State Medicaid Agencies • Screenings, Assessments, and Treatments, Individual and Family |
| Common Place of Service | • 11 - Office • 99 - Other Place of Service • None |
| Common Modifiers | • None • U3 • UD |
| Complexity Level | High |
National average reimbursement for HCPCS T1026 by major payers:
$65.23
$46.14
$36.31
$2,289.75
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS T1026. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the T1026 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.
HCPCS T1026 vs. Other Screenings, Assessments, and Treatments, Individual and Family Codes
The HCPCS T1026 code is part of the National Codes Established for State Medicaid Agencies services used for Screenings, Assessments, and Treatments, Individual and Family. 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 HCPCS T1026 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.
| HCPCS Code | Complexity Level | Description |
|---|---|---|
| T1025 | Moderate | Intensive, extended multidisciplinary services provided in a clinic setting to children with complex medical, physical, mental and psychosocial impairments, per diem |
| T1026 | High | Intensive, extended multidisciplinary services provided in a clinic setting to children with complex medical, physical, medical and psychosocial impairments, per hour |
| T1027 | Low | Family training and counseling for child development, per 15 minutes |
See what providers are getting paid in 2025 for T1026:
HCPCS T1026 Fee Schedule & Reimbursement Rates
The HCPCS T1026 fee schedule varies by payer type. Below are Medicare rates for 2025 and average in-network rates by state across major payers:
Reimbursement rates depend on provider contracts, region, and payer. Always verify rates with your insurance provider or medical billing department.
What is price transparency?
The Price Transparency Rule is a federal law that took effect in July 2022, requiring all commercial payers to publicly disclose their prices through machine-readable files (MRFs). In short, this regulation mandates that insurance companies make healthcare costs transparent to the public.
Our data comes directly from these insurer-posted MRFs, ensuring compliance with the Price Transparency Rule. While PayerPrice is working toward a future where providers and payers collaborate for 100% upfront price certainty, it's important to acknowledge that data limitations and occasional errors may exist.
Healthcare Price Transparency Rule
cms.govConsumer Guide To Healthcare Prices
aha.orgGlossary of Healthcare Terms
healthcare.govUnlock access to price transparency insights today.
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