CPT 28153 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 28153 |
National average reimbursement for CPT 28153 by major payers:
$508.92
$538.30
$543.84
$669.41
| 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 28153 | ||||||
United | 28153 | $963.78 | 1275687873 - DERMATOLOGY ASSOCIATES OF KENTUCKY, PSC | 610701663 - (KY) DERMATOLOGY ASSOCIATES OF KENTUCKY, P.S.C. | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28153 | $3801.00 | 1619071214 - RADS OF AMERICA, LLC, PREMIER RADIOLOGY PAIN MANAGEMENT CENTER | 200597581 - (TN) RADS OF AMERICA LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28153 | $1518.00 | 1477594422 - SURGERY CENTER OF AVENTURA LTD | 113765789 - (FL) SURGERY CENTER OF AVENTURA LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28153 | $2334.00 | 1316936016 - WESTLAKE SPINE & OUTPATIENT SURGERY CENTER | 204997865 - (CA) JOURNEY LITE OF THE CENTRAL COAST LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28153 | $1300.00 | 1447472659 - BROCKTON ENDOSCOPY SURGERY CENTER LP | 61706315 - (CA) BROCKTON ENDOSCOPY SURGERY CENTER LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28153 | $8541.08 | 1144348194 - ALLE-KISKI MEDICAL CENTER | 251875178 - (PA) HIGHMARK HEALTH | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28153 | $2944.00 | 1447788120 - NORCAL ORTHOPEDIC SURGERY CENTER, LLC | 821046949 - (CA) NORCAL ORTHOPEDIC SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28153 | $1968.00 | 1003332883 - DESERT VISTA SURGICAL CENTER LLC | 821195281 - (AZ) DESERT VISTA SURGICAL CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28153 | $968.00 | 1790822864 - NORTHWEST EYE SPECIALISTS,LLC | 860720868 - (AZ) NORTHWEST EYE SPECIALISTS, P.L.L.C. | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28153 | $1381.00 | 1295798346 - SUNRISE FLAMINGO SURGERY CENTER, LLC, FLAMINGO SURGERY CENTER | 621679326 - (NV) SUNRISE FLAMINGO SURGERY CENTER LLC | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28153 | $950.00 | 1407824436 - ORAL FACIAL SURGERY CENTER, LLC, SPECIALTY SURGERY CENTER | 621488965 - (TN) ORAL FACIAL SURGERY CENTER, INC. | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28153 | $1518.00 | 1457465403 - VENTURE AMBULATORY SURGERY CENTER | 743257508 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28153 | $950.00 | 1255792453 - MIDWEST EYE CONSULTANTS OHIO, INC, CATARACT & LASER INSTITUTE #351 | 300888250 - (OH) MIDWEST EYE CONSULTANTS OHIO INC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28153 | $1457.00 | 1164833687 - INTERVENTIONAL PAIN MANAGEMENT LLC | 452192531 - (IN) INTERVENTIONAL PAIN MANAGEMENT LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28153 | $1048.00 | 1205917101 - CATARACT & LASER CENTER, INC. | 42907424 - (MA) THE CATARACT AND LASER CENTER, I | MA | 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 28153 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 28153 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 28153 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, |
| 28153-CPT | Moderate | Resection Phalangeal Head |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 28153. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 28153 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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