CPT 28054 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 | Excision Procedures on the Foot and Toes Surgical Procedures on the Foot and Toes |
| 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 |
National average reimbursement for CPT 28054 by major payers:
$442.56
$498.28
$499.78
$415.85
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 28054 | $8705.00 | 1568410926 - MERIDIAN MEDICAL GROUP PC, MERIDIAN ENDOSCOPY CENTER | 208398421 | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28054 | $2100.00 | 1295855948 - MAINE EYE CENTER, PA | 10329291 - (ME) MAINE EYE CENTER | ME | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28054 | $2092.00 | 1205869211 - ROANOKE SURGERY CENTER, LP | 61755240 - (VA) ROANOKE SURGERY CENTER LP | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28054 | $2595.00 | 1982880274 - BURLINGTON COUNTY ENDOSCOPY CENTER LLC | 208205206 - (NJ) BURLINGTON COUNTY ENDOSCOPY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28054 | $475.00 | 1194999359 - JEFFREY L BOBER DPM PA, JEFFREY L BOBER DPM PA ASC | 521706931 - (MD) JEFFREY L BOBER DPM PA | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28054 | $528.00 | 1336272657 - ARIZONA DIGESTIVE CENTER, P.C. | 201544723 - (AZ) ARIZONA DIGESTIVE CENTER PC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28054 | $2307.00 | 1275292229 - SCOTTSDALE ENDOSCOPY ASC LLC | 873952617 | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28054 | $309.89 | 1801039763 - JANEEN GIBSON | 350593390 - DEACONESS HOSPITAL INC | TN | Certified Registered Nurse Anesthetist (367500000X) |
United | 28054 | $1198.00 | 1194233189 - CHAPIN ORTHOPEDIC SURGERY CENTER | 473916029 - (SC) CHAPIN ORTHOPEDIC SURGERY CENTER | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28054 | $1125.00 | 1184078503 - PIMA HEART ASC LLC, PIMA HEART ASC LLC | 812315336 - (AZ) PIMA HEART ASC LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28054 | $1854.00 | 1578142352 - CHELMSFORD SURGERY CENTER LLC | 854172372 - (MA) CHELMSFORD SURGERY CENTER LLC | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28054 | $2307.00 | 1295479780 - ADVENTHEALTH SURGERY CENTER DAVENPORT LLC | 881811228 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28054 | $1225.00 | 1205885746 - GLASGOW MEDICAL CENTER LLC, GLASGOW AMBULATORY SURGERY CENTER | 510320926 - (DE) GLASGOW MEDICAL CENTER, LLC | DE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28054 | $1090.00 | 1639290026 - JOHNS HOPKINS SURGERY CENTERS SERIES | 208707724 - (MD) JOHNS HOPKINS SURGERY CENTER SERIES | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28054 | $1135.00 | 1174679054 - CROSSROADS SURGERY CENTER, LLC | 562622609 - (TN) CROSSROADS SURGERY CENTER LLC | TN | 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 28054 vs. Other Surgical Procedures on the Foot and Toes Codes
The CPT 28054 code is part of the Excision Procedures on the Foot and Toes services used for Surgical Procedures on the Foot and Toes. 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 |
| 28022-CPT | Moderate | Arthrotomy Including Explorat, Arthrotomy Including Exploration Drainage Or Removal Ofloose Or Foreign Body Metatarsophalangealjoint Arthrotomy Including Exploration Drainag E 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). |
| 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.
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