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See a sample rate comparisonCPT 28160 Fee Schedule
Last Verified: October 2026
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.
Hemiphalangectomy Or Interphalang Joint Xcision Toe Proxim End, Hemiphalangectomy Or Interphalangeal Joint Excision Toe Proximal End
| 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 T6 - Right foot, second digit |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 28160 |
| Medicaid Fee Schedule | View Medicaid rates for 28160 |
National average reimbursement for CPT 28160 by major payers:
$517.72
$545.99
$548.43
$461.26
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CPT 28160
5 of 25 sample ratesHigher to lower in this preview
Alvarado Eye Surgery Center LLC
$2,859.00Published rateOlol Pontchartrain Surgery Center, LLC, Our Lady Of The Lake Pontchartrain Surgery Center
Olol Pontchartrain Surgery Cente
$1,563.00Published ratePremier-Covenant Astc LLC, Premier Ambulatory Surgery Center
Premiercovenant Astc LLC
$1,196.00Published rateTuscaloosa Surgical Center Lp, Tuscaloosa Sur
Tuscaloosa Surgical Center Lp
$825.00Published rateAndrew Krause
Deaconess Hospital Inc
$343.23Published rate
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See a sample payer proposalCPT 28160 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 28160 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 28160 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 |
|---|---|---|
| 28126-CPT | Moderate | Condylectomy,Phalangeal Base,Single Toe, |
| 28150-CPT | Moderate | Phalangectomy, Single, Each |
| 28153-CPT | Moderate | Resection Phalangeal Head |
| 28160-CPT | Moderate | Hemiphalangectomy Or Interphalang Joint Xcision Toe Proxim End, Hemiphalangectomy Or Interphalangeal Joint Excision Toe Proximal End |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 28160. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 28160 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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