CPT 28043 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 • 11 - Office |
| Common Modifiers | • None • RT - Right side of body • LT - Left side of body |
| Complexity Level | Moderate |
National average reimbursement for CPT 28043 by major payers:
$472.38
$507.08
$525.77
$632.36
| 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 28043 | ||||||
United | 28043 | $3008.00 | 1184051088 - SAN ANTONIO SURGICENTER, LLC, THE CENTER FOR SPECIAL SURGERY AT TCA | 300796793 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28043 | $1955.00 | 1336459353 - LONE STAR ENDOSCOPY CENTER LLC | 273635726 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28043 | $1666.00 | 1114965803 - ADVANCED ENDOSCOPY & SURGICAL CENTER LLC, ADVANCED ENDOSCOPY & SURGICAL CENTER | 113660090 - (NJ) ADVANCED ENDOSCOPY SURGICAL CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28043 | $872.00 | 1649252883 - FOUNDATION SURGERY AFFILIATE OF NACOGDOCHES LLC, NACOGDOCHES SURGERY CENTER | 731589339 - (TX) FOUNDATION SURGERY AFFILIATE OF NACOGDOCHES LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28043 | $1255.00 | 1720388465 - WEST ASC, LLC, CAMILLUS SURGERY CENTER | 273166743 - (NY) WEST ASC, LLC DBA CAMILLUS SURGERY CENTER | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28043 | $645.00 | 1003478744 - ACHY LEGS CLINICS LLC, CENTER FOR CARDIOVASCULAR EXCELLENCE | 820799709 - (TX) ACHY LEGS CLINICS LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28043 | $490.00 | 1881728590 - SYSTEM OPTICS LLC | 341572960 - (OH) SYSTEM OPTICS, INC. | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28043 | $500.00 | 1376556514 - EYE CARE SPECIALISTS PS, THE LASER AND SURGERY CENTER | 911895676 - (WA) EYECARE SPECIALIST, PS | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28043 | $890.00 | 1093459315 - PERFORMANCE HEALTH SURGICENTER, LLC | 881897351 - (FL) PERFORMANCE HEALTH SURGICENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28043 | $649.00 | 1881845907 - NORTH PACIFIC DERMATOLOGY PS | 204269950 - (WA) NORTH PACIFIC DERMATOLOGY PS | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28043 | $850.00 | 1962668319 - BOULDER MEDICAL CENTER, PC, BOULDER MEDICAL CENTER ASC | 840834835 - BOULDER MEDICAL CENTER, P.C. | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28043 | $1123.00 | 1588854772 - ALABAMA DIGESTIVE HEALTH ENDOSCOPY CENTER, LLC | 201243484 - (AL) ALABAMA DIGESTIVE HEALTH | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28043 | $1528.00 | 1821342858 - SURGCENTER OF ORANGE PARK, LLC, ORANGE PARK ENDOSCOPY CENTER | 460858710 - (FL) SURGCENTER OF ORANGE PARK LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28043 | $1258.00 | 1487716650 - CARONDELET ST. MARY'S NORTHWEST, LLC, CARONDELET FOOTHILLS SURGERY CENTER | 201086556 - (AZ) CAMP LOWELL SURGERY CENTER | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28043 | $852.00 | 1063999662 - SOUTHERN KENTUCKY SURGICENTER, LLC, GREENVIEW SURGERY CENTER | 474897131 - (KY) SOUTHERN KENTUCKY SURGICENTER LLC | KY | 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 28043 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 28043 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 28043 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 |
|---|---|---|
| 28039-CPT | Moderate | Excision Tumor Soft Tissue Foot Toe Subq 1.5 Cm |
| 28041-CPT | Moderate | Exc Tumor Soft Tissue Foot Toe Subfasc 1.5 Cm |
| 28043-CPT | Moderate | Removal (Less Than 1.5 Centimeters) Tissue Growth Beneath The Skin Of Foot Or Toe |
| 28045-CPT | Moderate | Excision, Tumor, Soft Tissue Of Foot Or Toe, Subfascial (E.G., Intramuscular); Less Than 1.5 Cm |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 28043. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 28043 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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