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 |
| Medicare Fee Schedule | View Medicare rates for 28043 |
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 | $1152.00 | 1639804248 - WILLIS SURGICENTER, LLC | 842342776 - (TX) WILLIS SURGICENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28043 | $1276.00 | 1093085904 - ARIZONA ADVANCED ENDOSCOPY LLC | 453051125 - (AZ) ARIZONA ADVANCED ENDOSCOPY, LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28043 | $864.00 | 1730121401 - SALEM ENDOSCOPY CENTER, LLC | 202447516 - (OR) SALEM ENDOSCOPY CENTER LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28043 | $1892.00 | 1619245230 - AMBULATORY SURGICAL PAVILION AT ROBERT WOOD JOHNSON LLC | 800768614 - (NJ) AMBULATORY SURGICAL PAVILION AT ROBERT WOOD JOHNSON LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28043 | $1072.50 | 1831551266 - INOV8 SURGICAL AT MEMORIAL CITY, INOV8 SURGICAL | 475640889 - (TX) INOV8 SURGICAL AT MEMORIAL CITY | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28043 | $401.00 | 1205853041 - EUCLID ENDOSCOPY CENTER, LP | 203197449 - (CA) EUCLID ENDOSCOPY CENTER LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28043 | $572.00 | 1750312435 - CENTRAL ARIZONA ENDOSCOPY LLC | 203643513 - (AZ) CENTRAL ARIZONA ENDOSCOPY LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28043 | $670.00 | 1487171575 - AMERICAN ACCESS CARE OF RICHMOND ASC LLC, AZURA SURGERY CENTER RIVER CITY | 814550552 - (VA) AMERICAN ACCESS CARE OF RICHMOND ASC LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28043 | $725.00 | 1881101335 - BROWN MEDICINE, BROWN MEDICINE ENDOSCOPY CENTER | 50450410 - BROWN MEDICINE | RI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28043 | $600.00 | 1124559679 - MIDATLANTIC ENDOSCOPY LLC, MID-ATLANTIC GASTROINTESTINAL CENTER III | 814079161 | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28043 | $955.00 | 1003909789 - OREGON TRAIL EYE SURGERY CENTER, INC | 200121578 - (NE) OREGON TRAIL EYE SURGERY CENTER INC | NE | 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 | $360.00 | 1346270428 - BALTIMORE AMBULATORY CENTER FOR ENDOSCOPY | 521913193 - (MD) BALTIMORE AMBULATORY CENTER FO | MD | 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 | 28043 | $875.00 | 1477905271 - KATY ASC, LP, ADVANCED CARDIOVASCULAR & SURGERY CENTER AT METHODIST WEST HOUSTON | 813141435 | TX | 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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