How much does Medicare pay for CPT 26123?

Medicare allowed an average of $1185.14 per service and paid $935.11 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $6115.38, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 26123?

Removal of connective tissue of palm and release of finger, first digit. It was billed 4,602 times to 4,454 Medicare beneficiaries by 278 providers in 2024.

Does 26123 pay differently in an office than a hospital?

Yes. The allowed amount averaged $883.02 in an office setting and $1188.53 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 26123 most?

Ambulatory Surgical Center, with 2,625 services from 149 clinicians. Next are Hand Surgery, Orthopedic Surgery, Plastic and Reconstructive Surgery.

CPT 26123

Removal of connective tissue of palm and release of finger, first digit

$1185.14Medicare-allowed amount per service, averaged across 4,602 services

Providers submitted

$6115.38

Asking price, not received

Medicare allowed

$1185.14

The fee schedule figure

Medicare paid

$935.11

Balance is patient coinsurance

Providers submitted an average of $6115.38 for this code and Medicare allowed $1185.14 — 5.2× 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 $935.11 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $883.02
Hospital / facility: $1188.53

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 51 services were billed in an office setting and 4,551 in a facility.

Services: 4,602
Beneficiaries: 4,454
Providers billing it: 278
Total allowed: $5,454,014

What Medicare pays for CPT 26123

Across 4,602 services billed by 278 providers to 4,454 beneficiaries, Medicare allowed an average of $1185.14 per service. 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 26123

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ambulatory Surgical Center	2,625	2,538	$1461.39	149
Hand Surgery	1,182	1,141	$820.52	76
Orthopedic Surgery	590	575	$816.85	40
Plastic and Reconstructive Surgery	170	166	$810.58	10
General Surgery	35	34	$808.50	3

26123 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
California	716	$1342.96	$908.07	39
Florida	376	$1064.23	$869.88	22
Virginia	330	$1075.30	$877.65	18
Washington	248	$1328.66	$1013.18	16
Texas	237	$999.80	$832.74	14
Maryland	226	$1225.70	$961.64	12
Pennsylvania	210	$1181.00	$945.03	13
Tennessee	172	$1127.53	$981.93	9
Massachusetts	165	$1122.03	$865.19	11
Arizona	149	$1229.45	$990.70	9
North Carolina	148	$1265.74	$1049.54	8
Delaware	122	$1149.74	$915.85	6
Georgia	110	$1139.42	$979.17	7
Colorado	98	$1257.54	$966.52	7
Ohio	89	$1238.22	$1008.19	6
Illinois	83	$1318.25	$1075.24	6
Michigan	82	$1017.93	$818.26	6
Kentucky	78	$971.52	$825.48	6
Connecticut	74	$1267.67	$959.67	5
Indiana	72	$1278.34	$1035.08	3
South Carolina	68	$1010.61	$871.82	5
Arkansas	62	$933.51	$832.81	4
Nevada	61	$1045.81	$821.76	4
Mississippi	56	$1092.19	$970.63	2
Oregon	51	$1234.56	$974.39	3
Wisconsin	51	$1274.13	$1033.29	4
Kansas	46	$1008.27	$868.16	3
North Dakota	45	$1078.28	$897.41	3
Missouri	43	$1161.82	$963.24	3
Alabama	37	$1087.32	$1031.60	2
Louisiana	33	$978.18	$848.99	2
New Hampshire	30	$1489.83	$1181.52	2
Minnesota	28	$1543.10	$1177.29	2
Utah	26	$1091.44	$896.73	2
Nebraska	24	$1421.85	$1184.51	2
Iowa	23	$1361.90	$1185.26	2
Idaho	22	$1073.64	$926.29	2
Oklahoma	22	$781.91	$664.55	2
New York	19	$1495.09	$1190.73	1
New Mexico	18	$1420.55	$1189.13	1
Rhode Island	15	$1495.52	$1183.99	1
Alaska	14	$1555.66	$1148.18	1
Vermont	12	$795.43	$628.40	1
Montana	11	$1426.39	$1190.71	1

Related codes

26160Removal of growth of tendon finger or hand$494.74
26145Repair of tendon$426.62

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.