CPT 28050 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 | 22 - On Campus Outpatient Hospital 24 - Ambulatory Surgical Center |
| Common Modifiers | None RT - Right side of body LT - Left side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 28050 |
| Medicaid Fee Schedule | View Medicaid rates for 28050 |
National average reimbursement for CPT 28050 by major payers:
$549.12
$570.42
$572.32
$486.27
CPT 28050 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 28050 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 28050 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 |
|---|---|---|
| 28050-CPT | Moderate | Biopsy Of Joint In Foot, Surgery To Explore A Foot Joint. The Procedure Includes Removing A Tissue Sample For Testing (Biopsy). |
| 28052-CPT | Moderate | Biopsy Of Joint In Foot, Surgery To Explore A Foot Joint. The Procedure Includes Removing A Tissue Sample For Testing (Biopsy). |
| 28054-CPT | Moderate | Remove Toe Tissue Sample, Surgery To Explore A Toe Joint. The Procedure Removes A Sample Of Tissue For Testing (Biopsy). |
| 28072-CPT | Moderate | Remove Foot Joint Lining, Surgery To Remove Lining Of Foot Joint. The Procedure Is Done To Relieve Pain And Increase Joint Mobility. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 28050. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 28050 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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