CPT 28104 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 |
| Medicare Fee Schedule | View Medicare rates for 28104 |
National average reimbursement for CPT 28104 by major payers:
$651.61
$688.76
$720.86
$860.87
| 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 28104 | ||||||
United | 28104 | $1635.00 | 1780076885 - MURRELLS INLET ASC LLC, CAROLINA COAST SURGERY CENTER | 454450466 - (SC) MURRELLS INLET ASC, LLC DBA CAROLINA COAST SURGERY CENTER | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28104 | $925.00 | 1053508077 - JOURNEY LITE OF CINCINNATI, LLC | 208861350 - (OH) JOURNEYLITE OF CINCINNATI, LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28104 | $2206.00 | 1356396857 - HOLSTON VALLEY AMBULATORY SURGERY CENTER, LLC | 621816864 | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28104 | $2758.00 | 1942231204 - SURGICAL INSTITUTE, LLC | 810911558 - (NJ) SURGICAL INSTITUTE LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28104 | $2808.00 | 1851407399 - SOUTHERN NEW MEXICO SURGERY CENTER, LLC | 201826172 - (NM) SOUTHERN NEW MEXICO SURGERY CENTER | NM | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28104 | $2307.00 | 1588610190 - SUMMIT AMBULATORY SURGICAL CENTER, LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28104 | $1858.00 | 1861059818 - FISHERS SPECIALTY SURGERY CENTER, LLC, ORTHOALLIANCE OF INDIANA | 833241405 - (IN) FISHERS SPECIALTY SURGERY CENTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28104 | $3657.00 | 1639553779 - UNIVERSITY OF MINNESOTA HEALTH CLINICS AND SURGERY CENTER, INC., M HEALTH CLINICS AND SURGERY CENTER | 465444821 - (MN) UNIVERSITY OF MINNESOTA HEALTH CLINICS AND SURGERY CENTER INC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28104 | $750.00 | 1639237092 - MUSCULOSKELETAL AMBULATORY SURGERY CENTER INC, THE SURGERY CENTER AT POINTE WEST | 650829385 - (FL) MUSCULOSKELETAL AMBULATORY SURGERY CENTER | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28104 | $3500.00 | 1750347472 - BAYLOR SURGICARE AT NORTH DALLAS, LLC, BAYLOR SCOTT & WHITE SURGICARE-NORTH DALLAS | 752900902 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28104 | $2762.00 | 1548446669 - INNOVIS HEALTH, LLC, ESSENTIA HEALTH WAHPETON ASC | 261175213 - INNOVIS HEALTH LLC | ND | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28104 | $4304.00 | 1770810798 - MIDTOWN SURGERY CENTER, LLC | 271462435 - (NY) MIDTOWN SURGERY CENTER, LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28104 | $3096.00 | 1275158495 - BCC CHANDLER LLC | 851284830 - (AZ) BCC CHANDLER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28104 | $825.00 | 1356488837 - RIDGEWOOD SURGERY AND ENDOSCOPY CENTER LLC | 204239587 - (KS) RIDGEWOOD SURGERY AND ENDOSCOPY CENTER, LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28104 | $792.00 | 1649325713 - LIBERTY EYE SURGICAL CENTER, LIBERTY SURGICAL CENTER | 200054137 - (PA) LIBERTY EYE SURGICAL CENTER, LLC | PA | 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 |
Want to see your competitors' rates?
Start your trial today to unlock complete access to provider rates and fee schedules in your area.
Here's what you can do with PayerPrice
Renegotiate your managed care contracts
Benchmark your current rates against market averages to identify opportunities for rate optimization.
Prospect for new business using fee schedules
Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.
Integrate real-time payer data into your workflows
Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.
PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.
CPT 28104 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 28104 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 28104 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 |
|---|---|---|
| 28100-CPT | Moderate | Excis/Curet Bone Cyst/Tumor,Talusor Cal |
| 28102-CPT | Moderate | Excision Or Curettage Of Bone Cyst Or Benign Tumor, Talus Or Calcaneus; With Iliac Or Other Autograft (Includes Obtaining Graft) |
| 28104-CPT | Moderate | Exc Lesion Tarsal/Metatarsal |
| 28106-CPT | Moderate | Excision Or Curettage Of Bone Cyst Or Benign Tumor, Tarsal Or Metatarsal, Except Talus Or Calcaneus; With Iliac Or Other Autograft (Includes Obtaining Graft) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 28104. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 28104 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.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 28104) and we'll show you how you compare in 15 minutes or less.