CPT 25628 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Surgery • Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | • 24 - Ambulatory Surgical Center • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • LT - Left side of body • RT - Right side of body |
| Complexity Level | Moderate |
National average reimbursement for CPT 25628 by major payers:
$940.57
$963.49
$1,022.38
$1,208.89
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 25628 | ||||||
United | 25628 | $22760.00 | 1528069218 - NORTHSHORE REGIONAL MEDICAL CENTER DBA THE SURGERY SUITE, THE SURGERY SUITE | 720502505 - (LA) OCHSNER CLINIC FOUNDATION | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25628 | $6492.00 | 1346693124 - VILLAGES ENDOSCOPY CENTER LLC | 813250494 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25628 | $5246.00 | 1881804508 - FAIRFIELD SURGERY CENTER, LLC | 61555691 - (CT) FAIRFIELD SURGERY CENTER LLC | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25628 | $2891.00 | 1720099260 - MEAH ASC MANAGEMENT, LLC | 760663270 - (TX) MEAH ASC MANAGEMENT LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25628 | $7888.00 | 1952814386 - ADVANCED SURGICAL CARE OF BOERNE, LLC | 821680961 - (TX) ADVANCED SURGICAL CARE OF BOERNE LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25628 | $4000.00 | 1134497910 - UROLOGICAL SURGICAL CENTER LLC | 451496270 - (GA) UROLOGICAL SURGICAL CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25628 | $1065.00 | 1679566228 - AMBULATORY FOOT AND ANKLE CENTER, INC. | 521910756 - (MD) AMBULATORY FOOT AND ANKLE CENTER INC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25628 | $12899.00 | 1346235058 - EAST MEQUON SURGERY CENTER LLC | 861075286 - (WI) EAST MEQUON SURGERY CENTER LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25628 | $11344.00 | 1700341468 - PORT WARWICK SURGERY CENTER, LLC | 832749039 - (VA) PORT WARWICK SURGERY CENTER LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25628 | $1563.00 | 1255394771 - DOCTORS HOSPITAL SURGERY CENTER, L.P. | 861072579 - (GA) DOCTORS HOSPITAL SURGERY CENTER LP | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25628 | $2896.00 | 1790714525 - PLASTIC SURGERY CENTER OF MERIDIAN, LLC | 710898618 - (MS) PLASTIC SURGERY CENTER OF MERIDIAN LLC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25628 | $12746.00 | 1902052350 - SURGERY CENTER, LLC | 263169180 - (WI) THE SURGERY CENTER, LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25628 | $3199.00 | 1427005313 - WESTERN WASHINGTON MEDICAL GROUP, INC PS, WESTERN WASHINGTON MEDICAL GROUP ENDOSCOPY CENTER | 911602128 - (WA) WESTERN WASHINGTON MEDICAL GROUP, INC., P.S. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25628 | $2500.00 | 1033468442 - CORNERSTONE SURGICARE LLC | 460563529 - (FL) CORNERSTONE SURGICARE LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 25628 | $6492.00 | 1154323988 - CENTRAL VIRGINIA SURGI-CENTER LP, SURGI-CENTER OF CENTRAL VIRGINIA | 752967162 - (VA) CENTRAL VIRGINIA SURGICENTER LP | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 25628 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 25628 code is part of the Surgery services used for Surgical Procedures on the Musculoskeletal System. 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 CPT 25628 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.
| Code | Complexity | Description |
|---|---|---|
| 25624-CPT | Moderate | Close Carpal Scaphoid W Manip |
| 25628-CPT | Moderate | Open Carpal Scaphoid W/Wo Fix |
| 25630-CPT | Moderate | Treatment Of Closed Carpal Bone Fracture (Excluding Carpal Scaphoid (Navicular)); Without Manipulation, Each B |
| 25635-CPT | Moderate | Treatment Of Closed Carpal Bone Fracture (Excluding Carpal Scaphoid (Navicular)); With Manipulation, Each Bone |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 25628. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 25628 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.
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