CPT 28046 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 28046 by major payers:
$984.65
$1,002.58
$981.40
$1,210.42
| 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 28046 | ||||||
United | 28046 | $803.00 | 1558050831 - BAPTIST HEALTH SURGERY CENTER, LLC | 650663357 - (FL) BAPTIST HEALTH SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28046 | $645.00 | 1043361587 - CENTER FOR ASSISTED REPRODUCTION LABORATORY AND SURGERY CENTER, INC. | 752829914 - (TX) CENTER FOR ASSISTED REPRODUCTION LABORATORY AND SURGERY CENTER INC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28046 | $1361.00 | 1780218115 - SURGERY CENTER OF FORT WAYNE | 825163478 - (IN) SURGERY CENTER OF FORT WAYNE LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28046 | $597.00 | 1497740872 - SHASTA EYE SURGEONS INC, SURGERY CENTER OF NORTHERN CALIFORNIA | 205757123 - (CA) SHASTA EYE SURGEONS INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28046 | $3130.00 | 1720118102 - CENTRAL LOUISIANA AMBULATORY SURGICAL CENTER LLC | 264732898 - (LA) CENTRAL LOUISIANA SURGICAL HOSPITAL, LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28046 | $880.00 | 1225308257 - CROWN VALLEY OUTPATIENT SURGICAL CENTER LLC, MISSION ENDOSCOPY CENTER | 454125214 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28046 | $550.00 | 1891133302 - HANFORD SPECIALTY SURGERY CENTER, PC | 454954590 - (CA) HANFORD SPECIALTY SURGERY CENTER PC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28046 | $1276.00 | 1396174454 - SURGERY CENTER OF SCOTTSDALE LLC | 731553441 - (AZ) SURGERY CENTER OF SCOTTSDALE LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28046 | $505.00 | 1396727418 - ENDOSCOPY CENTER OF LITTLE ROCK,LLC, RIC LR LLC | 20703428 - (AR) ENDOSCOPY CENTER OF LITTLE ROCKLLC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28046 | $1276.00 | 1740260926 - STARK AMBULATORY SURGERY CENTER, LLC | 611448511 - (OH) STARK AMBULATORY SURGERY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28046 | $602.00 | 1386739498 - GEORGIA LITHOTRIPSY AND LASER CENTER | 581879891 - (GA) GEORGIA LITHOTRIPSY AND LASER CENTER | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28046 | $618.00 | 1720048242 - MARYLAND SURGERY CENTER FOR WOMEN LLC, MARYLAND SURGERY CENTER | 522215638 - (MD) MARYLAND SURGERY CENTER FOR WOMEN, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28046 | $2378.00 | 1316072234 - ARIA HEALTH SYSTEM, ARIA HEALTH FRANKFORD CAMPUS SPU | 230596940 - (PA) JEFFERSON HEALTH-NORTHEAST | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28046 | $1258.00 | 1275545279 - SURGERY CENTER OF COLUMBIA LP | 205227138 - (MO) SURGERY CENTER OF COLUMBIA LP | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28046 | $1258.00 | 1194935577 - MILLENNIUM SURGICAL CENTER LLC | 205225327 - (NJ) MILLENNIUM SURGICAL CENTER, LLC | NJ | 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 28046 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 28046 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 28046 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 |
|---|---|---|
| 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) |
| 28047-CPT | High | Radical Resection Of Tumor (Eg Sarcoma) Soft Tissue Of Foot Or Toe; 3 Cm Or Greater (Revised 01/01/2014) |
| 28171-CPT | High | Radical Resection Of Tumor Bone; Tarsal (Except Talus Or Calcaneus) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 28046. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 28046 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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