Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonCPT 28054 Fee Schedule
Last Verified: September 2026
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.
Remove Toe Tissue Sample, Surgery To Explore A Toe Joint. The Procedure Removes A Sample Of Tissue For Testing (Biopsy).
| 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 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 28054 |
| Medicaid Fee Schedule | View Medicaid rates for 28054 |
National average reimbursement for CPT 28054 by major payers:
$442.56
$498.28
$499.78
$415.85
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 28054.
CPT 28054
5 of 25 sample ratesHigher to lower in this preview
Meridian Medical Group PC, Meridian Endoscopy Center
$8,705.00Published rateAdventhealth Surgery Center Davenport LLC
$2,307.00Published rateAmsc, LLC, Downtown Bronx Asc
Amsc LLC
$1,500.00Published rateZion Eye Institute, Inc
Zion Eye Institute Inc
$1,000.00Published rateTodd Aud
Deaconess Hospital Inc
$309.89Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 28054 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 28054 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 28054 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 |
|---|---|---|
| 28020-CPT | Moderate | Arthrotomy Including Explorat, Arthrotomy Including Exploration Drainage Or Removal Ofloose Or Foreign Body Intertarsal Or Tarsometatarsal Joint Arthrotomy Including Exploration Drainage Or Removal Of |
| 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). |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 28054. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 28054 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.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 28054) and we'll show you how you compare in 15 minutes or less.