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 |
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 | $1300.00 | 1447472659 - BROCKTON ENDOSCOPY SURGERY CENTER LP | 61706315 - (CA) BROCKTON ENDOSCOPY SURGERY CENTER LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28153 | $2880.00 | 1144283292 - LAFAYETTE SURGERY CENTER LIMITED PARTNERSHIP | 943419282 - (LA) LAFAYETTE SURGERY CENTER LIMITED PARTNERSHIP | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28153 | $1300.00 | 1104896422 - NORTH IDAHO PAIN CENTER LLC | 203305236 | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28153 | $870.00 | 1982637492 - TOMOKA SURGERY CENTER, LLC | 201218596 - (FL) TOMOKA SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28153 | $1283.00 | 1053560896 - ASC DEVELOPMENT COMPANY, LLC, NATIONAL SPINE AND PAIN CENTERS | 203405773 - (MD) ASC DEVELOPMENT COMPANY LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28153 | $2206.00 | 1801146535 - SURGCENTER AT PARADISE VALLEY, LLC, SURGCENTER AT PIMA CROSSING | 455364868 - (AZ) SURGCENTER AT PARADISE VALLEY | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28153 | $1102.00 | 1366529638 - NGC ENDOSCOPY SERVICES LLC | 931307280 - (OR) NGC ENDOSCOPY SERVICES LLC | OR | 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 | $475.00 | 1356311419 - RIVERSIDE AMBULATORY SURGERY CENTER LLC | 522233625 - (MD) RIVERSIDE AMBULATORY SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28153 | $8705.00 | 1205939345 - BELTWAY SURGERY CENTERS LLC, INDIANA HAND TO SHOULDER BELTWAY SURGERY CENTER | 352072586 | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28153 | $2323.00 | 1245450295 - MDSINE, LLC, SPINE INSTITUTE OF NEW ENGLAND | 208141112 - (MA) MDSINE LLC | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28153 | $1207.00 | 1730252487 - J C PITTS ENTERPRISES INC, ONTARIO SURGERY CENTER | 930983555 - (OR) J C PITTS ENTERPRISES INC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28153 | $1820.00 | 1013425933 - REX SURGERY CENTER OF WAKEFIELD, LLC | 465511168 - (NC) REX SURGERY CENTER OF WAKEFIELD LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28153 | $1615.00 | 1477949766 - DESCHUTES SURGERY CENTER, LLC, DESCHUTES SURGERY CENTER, LLC | 472920584 - (OR) DESCHUTES SURGERY CENTER LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28153 | $660.00 | 1780664185 - HILLMONT ASC LP, SPRINGFIELD AMBULATORY SURGERY CENTER | 621641866 | 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 |
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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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