How much does Medicare pay for CPT 26055?

Medicare allowed an average of $401.31 per service and paid $314.76 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $3142.69, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 26055?

Incision of tendon covering of finger. It was billed 122,098 times to 90,188 Medicare beneficiaries by 3,022 providers in 2024.

Does 26055 pay differently in an office than a hospital?

Yes. The allowed amount averaged $470.62 in an office setting and $391.95 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 26055 most?

Ambulatory Surgical Center, with 45,625 services from 875 clinicians. Next are Hand Surgery, Orthopedic Surgery, Plastic and Reconstructive Surgery.

CPT 26055

Incision of tendon covering of finger

$401.31Medicare-allowed amount per service, averaged across 122,098 services

Providers submitted

$3142.69

Asking price, not received

Medicare allowed

$401.31

The fee schedule figure

Medicare paid

$314.76

Balance is patient coinsurance

Providers submitted an average of $3142.69 for this code and Medicare allowed $401.31 — 7.8× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $314.76 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $470.62
Hospital / facility: $391.95

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 14,526 services were billed in an office setting and 107,572 in a facility.

Services: 122,098
Beneficiaries: 90,188
Providers billing it: 3,022
Total allowed: $48,999,148

What Medicare pays for CPT 26055

Across 122,098 services billed by 3,022 providers to 90,188 beneficiaries, Medicare allowed an average of $401.31 per service. That is 1.4 services per beneficiary, so this is a code patients typically receive more than once. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 26055

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ambulatory Surgical Center	45,625	33,726	$621.67	875
Hand Surgery	39,234	29,075	$273.90	1,000
Orthopedic Surgery	33,604	24,670	$262.97	1,033
Plastic and Reconstructive Surgery	2,907	2,147	$292.76	86
General Surgery	514	390	$264.93	17
Family Practice	71	60	$341.57	4
Sports Medicine	50	43	$272.22	3
Diagnostic Radiology	35	31	$283.56	1
Physical Medicine and Rehabilitation	20	14	$177.15	1
Internal Medicine	19	16	$497.94	1
Osteopathic Manipulative Medicine	19	16	$236.49	1

26055 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
Florida	11,675	$401.73	$326.96	227
California	8,086	$487.93	$326.59	208
Texas	6,356	$353.66	$286.75	172
New York	5,486	$419.19	$303.01	139
Illinois	5,452	$431.35	$338.11	130
Pennsylvania	5,355	$371.97	$299.05	134
Ohio	4,534	$379.19	$312.67	117
Virginia	4,371	$383.92	$312.68	90
Arizona	4,232	$403.79	$321.71	74
North Carolina	3,793	$401.92	$335.07	105
Georgia	3,703	$415.50	$340.05	104
Maryland	3,653	$450.30	$351.13	87
New Jersey	3,616	$453.26	$329.43	85
Tennessee	3,515	$378.93	$332.82	83
Washington	3,489	$414.63	$312.23	86
Indiana	3,264	$387.50	$320.89	86
South Carolina	3,170	$361.98	$301.86	69
Colorado	3,013	$432.42	$341.67	67
Massachusetts	2,823	$384.43	$278.83	78
Michigan	2,459	$434.43	$354.57	84
Wisconsin	2,066	$363.19	$299.06	56
Alabama	1,876	$366.70	$333.41	51
Missouri	1,797	$353.01	$293.57	56
Kansas	1,571	$353.20	$292.35	40
Mississippi	1,513	$377.41	$348.31	29
Iowa	1,480	$403.38	$344.86	38
Minnesota	1,340	$441.03	$346.68	47
Delaware	1,327	$405.45	$319.17	16
Connecticut	1,276	$450.27	$330.43	41
Oregon	1,219	$450.19	$344.22	37
Louisiana	1,209	$341.10	$299.60	34
Nebraska	1,206	$357.44	$300.04	30
Nevada	1,129	$394.27	$308.00	22
Oklahoma	1,127	$287.44	$242.85	32
New Hampshire	1,117	$413.11	$321.93	26
Utah	1,032	$429.12	$350.50	28
Arkansas	1,020	$331.77	$281.94	27
Kentucky	995	$322.66	$271.85	31
Idaho	933	$339.96	$291.27	25
Montana	869	$426.44	$343.10	18
Wyoming	578	$418.63	$341.61	18
South Dakota	516	$207.15	$165.28	12
Rhode Island	440	$451.31	$354.41	10
New Mexico	407	$345.04	$279.46	13
North Dakota	358	$299.43	$240.90	10
Alaska	344	$542.16	$375.91	11
Hawaii	308	$429.67	$320.67	8
Vermont	282	$308.42	$244.38	8
Maine	281	$409.23	$324.13	9
District of Columbia	214	$358.19	$257.69	6
West Virginia	140	$304.89	$249.51	6
Guam	70	$272.76	$203.40	1
Puerto Rico	13	$446.54	$515.95	1

Related codes

26040Release of tissue of palm$400.49

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.