CPT 28160 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 • T6 - Right foot, second digit |
| Complexity Level | Moderate |
National average reimbursement for CPT 28160 by major payers:
$517.72
$545.99
$548.43
$679.41
| 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 28160 | ||||||
United | 28160 | $3746.00 | 1699738112 - NORTH AUSTIN SURGERY CENTER, L.P. | 200648730 - (TX) NORTH AUSTIN SURGERY CENTER LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28160 | $638.00 | 1376574814 - ROCHESTER ENDOSCOPY & SURGERY CENTER, L.L.C. | 61683897 - (MI) ROCHESTER ENDOSCOPY SURGERY CENTER LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28160 | $3877.00 | 1528339447 - CP SURGERY CENTER, LLC | 800776412 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28160 | $2119.00 | 1295776920 - ROSE AMBULATORY SURGERY CENTER LP | 200415436 - (CO) ROSE AMBULATORY SURGERY CENTER LP | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28160 | $1682.00 | 1174010011 - DTC SURGERY CENTER, LLC, OCC SURGERY CENTER AT INVERNESS | 825181311 - (CO) DTC SURGERY CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28160 | $1581.00 | 1407169212 - GEORGIA SPINE SURGERY CENTER, LLC, GNS SURGERY CENTER | 271111856 - (GA) GEORGIA SPINE SURGERY CENTER, LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28160 | $1806.00 | 1215939186 - ALL CITY FAMILY HEALTHCARE CENTER, INC. | 113423598 - (NY) ALL CITY FAMILY HEALTH CARE CENTER, INC. | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28160 | $1080.00 | 1285825075 - SUNNYSIDE SURGERY CENTER, LLC | 201164055 - (ID) SUNNYSIDE SURGERY CENTER LLC | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28160 | $2299.00 | 1255991238 - LEE SUMMIT ASC KC LLC, BEACON SURGERY CENTER | 831077983 - (MO) LEE SUMMIT ASC KC LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28160 | $994.00 | 1487608071 - SAN BERNARDINO EYE SURGERY CENTER, LLC, THE EYE SURGERY CENTER | 330991348 - SAN BERNARDINO EYE SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28160 | $2859.00 | 1962671487 - HYDE PARK SURGERY CENTER, LLC, HYDE PARK SURGERY CENTER, LP | 421731685 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28160 | $1525.00 | 1669720397 - PLEASANT VIEW SURGERY CENTER, LLC | 455254219 - (ID) PLEASANT VIEW SURGERY CENTER, LLC | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28160 | $1350.00 | 1376607309 - EMERALD SURGICAL CENTER LLC | 820485376 - (ID) EMERALD SURGICAL CENTER, L.L.C. | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28160 | $1563.00 | 1497090740 - OLOL PONTCHARTRAIN SURGERY CENTER, LLC, OUR LADY OF THE LAKE PONTCHARTRAIN SURGERY CENTER | 461379031 - (LA) OLOL PONTCHARTRAIN SURGERY CENTE | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28160 | $1750.00 | 1649871450 - ADVANCED HEART AND VEIN SURGERY CENTER, LLC | 844546684 - (CO) ADVANCED HEART AND VEIN SURGERY CENTER LLC | CO | 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 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 |
|---|---|---|
| 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, |
| 28160-CPT | Moderate | Hemiphalangectomyor Ip Joint Excis,Sing |
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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