CPT 28171 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address high-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 • 21 - Inpatient Hospital |
| Common Modifiers | • None • RT - Right side of body • 59 - Distinct Procedural Service • LT - Left side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 28171 |
National average reimbursement for CPT 28171 by major payers:
$1,397.67
$1,291.49
$1,384.75
$1,685.02
| 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 28171 | ||||||
United | 28171 | $9192.00 | 1881678662 - SURGERY AFFILIATE OF EL PASO, LLC, FOUNDATION SURGERY AFFILIATE OF EL PASO, LLC | 742797719 - (TX) SURGERY AFFILIATE OF EL PASO LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28171 | $1145.00 | 1861089666 - BARNET DULANEY PERKINS EYE CENTER, PC, BDPEC ASC TUCSON 5TH ST | 562589722 - BARNET DULANEY PERKINS EYE CENTER PLLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28171 | $1485.00 | 1619036381 - WILMINGTON AMBULATORY SURGICAL CENTER, LLC, AMERICAN SURGERY CENTER | 510385184 - (DE) WILMINGTON AMBULATORY SURGICAL CENTER LLC | DE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28171 | $957.00 | 1568437820 - FLORIDA ENDOSCOPY AND SURGERY CENTER, LLC, FLORIDA ENDOSCOPY & SURGERY CENTER | 593622500 - (FL) FLORIDA ENDOSCOPY AND SURGERY CENTER, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28171 | $1348.00 | 1922093293 - LEWIS & CLARK ORTHOPAEDIC INSTITUTE LLC | 352210163 - LEWIS & CLARK ORTHOPAEDIC, LLC 401(K) PLAN | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28171 | $1102.00 | 1134300080 - METAIRIE LA ENDOSCOPY ASC LLC, MGA GASTROINTESTINAL DIAGNOSTIC AND THERAPEUTIC CENTER-METAIRIE | 205904530 | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28171 | $1100.00 | 1952408783 - SHADYSIDE SURGI-CENTER, INC. | 251707086 - (PA) SHADYSIDE SURGICENTER INC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28171 | $1939.89 | 1497381438 - BERNARD NDEDI | 350593390 - DEACONESS HOSPITAL INC | IL | Emergency Medicine Physician (207P00000X) |
United | 28171 | $912.00 | 1346331329 - PHYSICIANS EYE SURGERY CENTER LLC, PHYSICIANS' EYE SURGERY CENTER | 571116347 - (SC) PHYSICIANS EYE SURGERY CENTER | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28171 | $640.00 | 1306963020 - BATTLE CREEK ENDOSCOPY & SURGERY LLC | 201914507 - (MI) BATTLE CREEK ENDOSCOPY & SURGERY CENTER PLLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28171 | $1011.00 | 1306214705 - GSI ASC, LLC | 474883816 - (OK) GSI ASC LLC | OK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28171 | $770.00 | 1568556488 - SUNCOAST EYE CENTER PA, SUNCOAST SURGERY INSTITUTE | 592337219 - (FL) SUNCOAST EYE CENTER PA | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28171 | $2388.00 | 1346693124 - VILLAGES ENDOSCOPY CENTER LLC | 813250494 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28171 | $1645.00 | 1699286922 - HUMBLE VASCULAR SURGICAL CENTER LLC | 820905971 - (TX) HUMBLE VASCULAR SURGICAL CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28171 | $689.00 | 1306885256 - EYE SURGICAL CENTER, LLC, THE INSTITUTE FOR REFRACTIVE AND INTRAOCULAR SURGERY | 200318724 - (OH) EYE SURGICAL CENTER LLC | OH | 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 28171 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 28171 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 28171 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 |
|---|---|---|
| 28039-CPT | Moderate | Excision Tumor Soft Tissue Foot Toe Subq 1.5 Cm |
| 28046-CPT | Moderate | Radical Resection Of Tumor (Eg Sarcoma) Soft Tissue Of Foot Or Toe; Less Than 3 Cm (Revised 01/01/2014) |
| 28047-CPT | High | Radical Resection Of Tumor (Eg Sarcoma) Soft Tissue Of Foot Or Toe; 3 Cm Or Greater (Revised 01/01/2014) |
| 28171-CPT | High | Radical Resection Of Tumor Bone; Tarsal (Except Talus Or Calcaneus) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 28171. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 28171 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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