How much does Medicare pay for CPT 26160?

Medicare allowed an average of $494.74 per service and paid $388.62 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $3411.01, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 26160?

Removal of growth of tendon finger or hand. It was billed 8,728 times to 8,234 Medicare beneficiaries by 481 providers in 2024.

Does 26160 pay differently in an office than a hospital?

Yes. The allowed amount averaged $513.33 in an office setting and $492.26 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 26160 most?

Ambulatory Surgical Center, with 4,198 services from 209 clinicians. Next are Hand Surgery, Orthopedic Surgery, Plastic and Reconstructive Surgery.

CPT 26160

Removal of growth of tendon finger or hand

$494.74Medicare-allowed amount per service, averaged across 8,728 services

Providers submitted

$3411.01

Asking price, not received

Medicare allowed

$494.74

The fee schedule figure

Medicare paid

$388.62

Balance is patient coinsurance

Providers submitted an average of $3411.01 for this code and Medicare allowed $494.74 — 6.9× 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 $388.62 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $513.33
Hospital / facility: $492.26

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. 1,028 services were billed in an office setting and 7,700 in a facility.

Services: 8,728
Beneficiaries: 8,234
Providers billing it: 481
Total allowed: $4,318,091

What Medicare pays for CPT 26160

Across 8,728 services billed by 481 providers to 8,234 beneficiaries, Medicare allowed an average of $494.74 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 26160

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ambulatory Surgical Center	4,198	3,977	$690.80	209
Hand Surgery	2,671	2,526	$320.41	161
Orthopedic Surgery	1,438	1,338	$301.19	88
Plastic and Reconstructive Surgery	331	307	$303.65	17
General Surgery	69	67	$325.76	5
Dermatology	21	19	$296.72	1

26160 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	819	$475.73	$384.25	40
California	741	$583.55	$394.29	43
Pennsylvania	433	$396.40	$316.45	23
Texas	429	$456.34	$373.91	22
Illinois	392	$574.34	$453.36	23
Tennessee	378	$444.18	$393.22	20
Virginia	373	$504.96	$405.67	19
New York	341	$558.92	$417.11	18
New Jersey	327	$469.21	$344.51	19
North Carolina	306	$489.61	$403.44	18
Arizona	282	$541.91	$434.63	17
South Carolina	256	$400.79	$340.20	16
Massachusetts	254	$390.32	$293.27	15
Washington	254	$533.62	$393.17	12
Georgia	244	$550.40	$450.91	15
Ohio	219	$485.49	$397.41	14
Alabama	175	$495.54	$441.08	10
Maryland	169	$562.83	$434.28	8
Indiana	162	$513.87	$427.80	9
Colorado	158	$554.85	$436.39	8
Kentucky	142	$276.46	$235.42	7
Nebraska	129	$508.46	$421.67	7
Mississippi	128	$434.33	$386.09	7
Louisiana	126	$477.38	$423.81	6
New Hampshire	112	$551.10	$433.30	7
Kansas	108	$352.69	$291.24	6
Wisconsin	102	$477.86	$372.95	6
Iowa	101	$612.03	$516.64	6
Arkansas	100	$435.97	$371.18	5
Oklahoma	98	$382.44	$327.46	5
Connecticut	93	$606.98	$457.85	5
Missouri	78	$387.58	$324.96	4
Montana	73	$548.56	$447.21	4
Nevada	70	$399.17	$317.12	4
Michigan	69	$496.32	$403.29	4
Delaware	69	$504.25	$413.25	5
Idaho	68	$435.53	$388.84	4
Utah	63	$585.31	$483.39	5
South Dakota	46	$278.07	$224.41	3
Minnesota	43	$761.57	$601.00	2
Rhode Island	37	$676.44	$524.16	2
Vermont	32	$578.52	$461.90	2
Alaska	31	$771.82	$563.49	1
Oregon	29	$529.11	$406.76	2
Maine	28	$635.19	$527.42	1
New Mexico	28	$656.54	$550.34	1
North Dakota	13	$248.50	$204.35	1

Related codes

26145Repair of tendon$426.62
26123Removal of connective tissue of palm and release of finger$1185.14

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.