CPT 26160: Excision of Lesion from Tendon Sheath or Joint Capsule, Hand/Finger
Medicare pays $683 and commercial payers pay $1375 on average nationally for this procedure.
CPT code 26160 describes surgical excision of a lesion (for example, a cyst or ganglion) from a tendon sheath or joint capsule in the hand or finger; this is a minor operative procedure performed by a hand or orthopedic surgeon, typically in an ambulatory surgery center, hospital outpatient department, or office-based procedure room and involves local or regional anesthesia and direct surgical removal of the lesion.
For related coverage guidance, see recent payer policy updates: Hip Arthroplasty (partial and total hip replacement), Shoulder Arthroplasty (Total, Partial, Reverse, Revision and Resurfacing), Artificial Lumbar Intervertebral Disc (Lumbar Total Disc Arthroplasty).
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National Reimbursement Benchmarks
Commercial averages sit above Medicare for CPT 26160: Blue Cross Blue Shield and BUCA mean rates ($1,900 and $1,375.20, respectively) are meaningfully higher than Medicare’s mean of $682.90, while other large payers like UnitedHealth Group ($847.90), Cigna ($743.60), and Aetna ($435.20) fall between those points. This positions Medicare near the lower-middle of the national spectrum, with BUCA representing a higher commercial benchmark.
Dispersion measured by the interquartile range (P75 minus P25) highlights variability across payers: Blue Cross Blue Shield shows the widest spread at $1,794.90 (P75 $2,678.90 minus P25 $884.60), followed by UnitedHealth Group at $540.20 and Cigna at $602.60; Aetna is relatively tight with a spread of $448.80. BUCA’s IQR is $1,238.50 and Medicare’s IQR is $86.00, making Medicare the tightest and Blue Cross Blue Shield the most dispersed among the listed payers.