CPT 28126 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 • 59 - Distinct Procedural Service • T9 - Right foot, fifth digit |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 28126 |
National average reimbursement for CPT 28126 by major payers:
$483.64
$514.90
$515.81
$643.78
| 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 28126 | ||||||
United | 28126 | $325.51 | 1215041710 - MARGREE SPIGHT | 350593390 - DEACONESS HOSPITAL INC | TN | Certified Registered Nurse Anesthetist (367500000X) |
United | 28126 | $624.00 | 1427545540 - ORBIS SURGERY CENTER LLC | 825184428 - (TX) ORBIS SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28126 | $1244.00 | 1699863258 - ROBERT E WAILES MD A PROFESSIONAL, PACIFIC SURGERY CENTER | 330113109 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28126 | $1403.00 | 1487782637 - EYEASSOCIATES SURGERY CENTER, INC | 581362384 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28126 | $1800.00 | 1982931465 - GARDEN GROVE SURGICAL CENTER INC | 271203227 - (CA) GARDEN GROVE SURGICAL CENTER INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28126 | $1919.00 | 1578610564 - HOLDINGS OF SPINECARE, LLC, SPINECARE LLP | 200950730 - (TX) HOLDINGS OF SPINECARE LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28126 | $1304.00 | 1366864514 - GREAT SOUTH BAY ENDOSCOPY CENTER, LLC | 463055867 - (NY) GREAT SOUTH BAY ENDOSCOPY CENTER LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28126 | $325.51 | 1255823399 - KENDRA STREICHER | 350593390 - DEACONESS HOSPITAL INC | IN | Physician Assistant (363A00000X) |
United | 28126 | $2007.00 | 1104341353 - BANNER PEORIA SURGERY CENTER LLC | 901182685 - (AZ) BANNER PEORIA SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28126 | $1650.00 | 1568503845 - MINNESOTA VASCULAR SURGERY CENTER | 204879005 - (MN) MINNESOTA VASCULAR SURGERY CENTER | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28126 | $975.00 | 1194708792 - OPHTHALMOLOGY CONSULTANTS OF FORT WAYNE PC, SURGERY CENTER OF OPHTHALMOLOGY CONSULTANTS | 351581864 - (IN) OPHTHALMOLOGY CONSULTANTS OF FORT WAYNE, P.C. | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28126 | $1450.00 | 1225188808 - LOS ANGELES ENDOSCOPY CENTER, LOS ANGELES AMBULATORY SURGERY CENTER | 954775738 - (CA) LOS ANGELES ENDOSCOPY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28126 | $2092.00 | 1205869211 - ROANOKE SURGERY CENTER, LP | 61755240 - (VA) ROANOKE SURGERY CENTER LP | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28126 | $1000.00 | 1891313532 - ROCKINGHAM EYE SURGERY CENTER, LLC | 842294161 - (VA) ROCKINGHAM EYE SURGERY CENTER LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28126 | $1450.00 | 1134497910 - UROLOGICAL SURGICAL CENTER LLC | 451496270 - (GA) UROLOGICAL SURGICAL CENTER LLC | GA | 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 28126 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 28126 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 28126 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 |
|---|---|---|
| 28114-CPT | High | Ostectomy, Complete Excision; All Metatarsal Heads, With Partial Proximal Phalangectomy, Excluding First Metatarsal (Eg, Clayton Type Procedure) |
| 28124-CPT | Moderate | Partial Excision (Craterization, Saucerization, Sequestrectomy, Or Diaphysectomy) Bone (Eg, Osteomyelitis Or Bossing); Phalanx Of Toe |
| 28126-CPT | Moderate | Condylectomy,Phalangeal Base,Single Toe, |
| 28150-CPT | Moderate | Phalangectomy, Single, Each |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 28126. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 28126 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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