CPT 28238 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 • LT - Left side of body • RT - Right side of body |
| Complexity Level | Moderate |
National average reimbursement for CPT 28238 by major payers:
$842.83
$889.82
$923.28
$1,109.99
| 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 28238 | ||||||
United | 28238 | $823.00 | 1669075495 - SAINT JOSEPH HEALTH ASC LLC | 611235517 - (KY) THE PAIN TREATMENT CENTER, INC. DBA STONE ROAD S | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28238 | $3023.00 | 1679526297 - WEST BLOOMFIELD SURGERY CENTER, LLC, LAKES SURGERY CENTER | 200449191 - (MI) WEST BLOOMFIELD SURGERY CENTER LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28238 | $4000.00 | 1487117370 - LIBERTY CORNER SURGICAL CENTER LLC | 833879253 - (NJ) LIBERTY CORNER SURGICAL CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28238 | $6492.00 | 1538773890 - ASC OF TRINITY, COMPREHENSIVE OUTPATIENT JOINT AND SPINE INSTITUTE | 833008593 - (FL) ASC OF TRINITY | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28238 | $3330.00 | 1184690570 - PAIN CARE SURGERY, PC | 371379699 - (IL) PAIN CARE SURGERY PC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28238 | $1976.00 | 1386004018 - COPPEL SURGICAL SOLUTIONS, NEVADA SURGICAL SUITES | 460641933 - (NV) COPPEL SURGICAL SOLUTIONS | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28238 | $1088.00 | 1982626974 - PHYSICIANS EYE SURGERY CENTER, INC | 911320378 - (WA) PHYSICIANS EYE SURGERY CENTER INC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28238 | $3365.00 | 1386196764 - ADVANCED SURGICAL & RESEARCH SOLUTIONS LLC | 811367583 - (OK) ADVANCED SURGICAL RESEARCH SOLUTIONS LLC | OK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28238 | $7528.00 | 1356878052 - PAVILION SURGERY CENTER LLC | 814376492 - (CA) PAVILION SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28238 | $4162.00 | 1760931349 - SF NASSAU ASC LLC | 300870382 - (NY) SF NASSAU ASC LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28238 | $6990.00 | 1023370251 - O'CONNOR BUILDING SURGERY CENTER LLC | 455437708 - (CA) OCONNOR BUILDING SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28238 | $3489.00 | 1730401571 - CHILDRENS SURGERY CENTER LLC, ADVENTHEALTH SURGERY CENTER MAITLAND | 262389638 - (FL) CHILDRENS SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28238 | $1143.00 | 1902863723 - OAK & MAIN SURGICENTER LLC | 223532371 - (NJ) OAK MAIN SURGICENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28238 | $576.00 | 1831551266 - INOV8 SURGICAL AT MEMORIAL CITY, INOV8 SURGICAL | 475640889 - (TX) INOV8 SURGICAL AT MEMORIAL CITY | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28238 | $4852.00 | 1194344606 - TIDELANDS HEALTH ASC LLC, TIDELANDS HEALTH SURGERY CENTER AT THE MARKET COMMON | 611930163 - (SC) TIDELANDS HEALTH ASC LLC | SC | 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 28238 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 28238 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 28238 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 |
|---|---|---|
| 28232-CPT | Moderate | Tenotomy Open Flexor Toe |
| 28234-CPT | Moderate | Tenotomy Open Extensor Foot/Toe |
| 28238-CPT | Moderate | Reconstruction (Advancement), Posterior Tibial Tendon With Excision Of Accessory Tarsal Navicular Bone (Eg, Kidner Type Procedure) |
| 28264-CPT | High | Capsulotomy Midtarsal Heyman Type |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 28238. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 28238 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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