CPT 28045 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 • RT - Right side of body • LT - Left side of body |
| Complexity Level | Moderate |
National average reimbursement for CPT 28045 by major payers:
$620.87
$644.52
$660.07
$798.01
| 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 28045 | ||||||
United | 28045 | $565.00 | 1053560896 - ASC DEVELOPMENT COMPANY, LLC, NATIONAL SPINE AND PAIN CENTERS | 203405773 - (MD) ASC DEVELOPMENT COMPANY LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28045 | $1179.00 | 1003861998 - PHYSICIANS SURGERY CENTER OF CHATTANOOGA, LLC, PHYSICIANS SURGERY CENTER OF CHATTANOOGA | 621817952 - (TN) PHYSICIANS SURGERY CENTER OF CHATTANOOGA LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28045 | $555.00 | 1346308954 - DAY SURGERY OF GRAND JUNCTION LLC, DAY SURGERY OF GRAND JUNCTION | 841097113 - (CO) DAY SURGERY OF GRAND JUNCTION LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28045 | $415.00 | 1447748470 - CTS SURGICAL ASSOCIATES LLC, CEDAR TREE SURGICAL CENTER | 825298503 | DE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28045 | $1276.00 | 1598996894 - SURGICAL ELITE OF AVONDALE, LLC | 270471437 - (AZ) SURGICAL ELITE OF AVONDALE LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28045 | $2480.00 | 1336391085 - MEMORIAL HERMANN SURGERY CENTER KINGSLAND LLC, MEMORIAL HERMANN SURGERY CENTER KINGSLAND | 263464776 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28045 | $630.00 | 1538110713 - CENTER FOR DIGESTIVE HEALTH LLC | 201606438 - (MS) CENTER FOR DIGESTIVE HEALTH LLC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28045 | $1258.00 | 1669574539 - MANCHESTER SURGERY CENTER, LLC | 205953313 | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28045 | $1520.00 | 1720398167 - CROSSTOWN SURGERY CENTER LLC | 272552748 | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28045 | $372.00 | 1942793823 - STARKVILLE SURGERY CENTER LLC | 465332869 - (MS) STARKVILLE SURGERY CENTER LLC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28045 | $618.00 | 1639499627 - GEORGIA UROLOGY, PA, GEORGIA UROLOGY ASC MARIETTA | 550846177 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28045 | $734.00 | 1174258107 - FW SPECIALTY SURGICARE, LLC | 854261198 - (TX) FW SPECIALTY SURGICARE LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28045 | $1245.00 | 1619519535 - ANDERSON SURGERY CENTER LLC | 834200085 - (IL) ANDERSON SURGERY CENTER LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28045 | $1072.50 | 1053328781 - LOS ALAMITOS SURGERY CENTER L P | 550823348 - (CA) LOS ALAMITOS SURGERY CENTER L P | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28045 | $525.00 | 1487776365 - SEYMOUR OPERATIONS LLC, FAIR PARK SURGERY CENTER | 203173824 - (AR) SEYMOUR OPERATIONS LLC | AR | 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 28045 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 28045 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 28045 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 |
| 28045-CPT | Moderate | Excision, Tumor, Soft Tissue Of Foot Or Toe, Subfascial (E.G., Intramuscular); Less Than 1.5 Cm |
| 28046-CPT | Moderate | Radical Resection Of Tumor (Eg Sarcoma) Soft Tissue Of Foot Or Toe; Less Than 3 Cm (Revised 01/01/2014) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 28045. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 28045 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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