CPT 28250 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 | • 22 - On Campus Outpatient Hospital • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • LT - Left side of body • RT - Right side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 28250 |
National average reimbursement for CPT 28250 by major payers:
$736.17
$757.92
$802.47
$955.28
| 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 28250 | ||||||
United | 28250 | $1062.00 | 1407227358 - BAPTIST SURGERY AND ENDOSCOPY CENTERS LLC, BAPTIST HEALTH SURGERY CENTER AT NORTHPOINT | 650592518 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28250 | $2025.00 | 1811546575 - FIRST COAST ORTHOPEDIC CENTER, LLC, FIRST COAST SURGERY CENTER | 822929226 - (FL) FIRST COAST ORTHOPEDIC CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28250 | $1600.00 | 1033363064 - TATTNALL HOSPITAL COMPANY, LLC, OPTIM SURGERY CENTER | 300466706 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28250 | $1986.00 | 1538647474 - PALOS HEALTH SURGERY CENTER, LLC | 352634975 - (IL) PALOS HEALTH SURGERY CENTER LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28250 | $2990.00 | 1881001758 - ASUCH SURGERY CENTER | 455067682 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28250 | $823.00 | 1316969058 - BETHESDA ENDOSCOPY CENTER, LLC | 521915901 - (MD) BETHESDA ENDOSCOPY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28250 | $2795.00 | 1992713010 - NORTHFIELD SURGICAL CENTER LLC, NORTHFIELD SURGICAL CENTER | 223509801 - (NJ) NORTHFIELD SURGICAL CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28250 | $806.00 | 1528039567 - PREMIER PROFESSIONAL SURGERY CENTER PC, PARKEYE SURGI CENTER | 381894684 - (MI) PARK EYE & SURGI CENTER | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28250 | $1326.00 | 1982954640 - BAKERSFIELD SPECIALTY SURGERY CENTER, PC | 454955212 - (CA) BAKERSFIELD SPECIALTY SURGERY CENTER PC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28250 | $818.00 | 1497347934 - INTEGRIS DDSI ENDOSCOPY CENTERS LLC | 854253589 | OK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28250 | $2206.00 | 1134126097 - PHYSICIAN'S SURGERY CENTER OF KNOXVILLE LLC | 621777892 - (TN) PHYSICIANS SURGERY CENTER OF KNOXVILLE LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28250 | $7081.00 | 1174969372 - AURORA GI ASC LLC, WISCONSIN DIGESTIVE HEALTH CENTER | 461848055 - (WI) AURORA GI ASC LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28250 | $1183.00 | 1245340603 - MOUNTAIN EMPIRE CATARACT & EYE SURGERY CENTER | 30408358 - (TN) MOUNTAIN EMPIRE CATARACT EYE SURGERY CENTER | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28250 | $1600.00 | 1144673526 - MURRIETA VALLEY SURGERY CENTER, INC.A PROFESSIONAL CORPORATION | 813020819 - (CA) MURRIETA VALLEY SURGERY CENTER INCA PROFESSIONAL CORPORATION | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28250 | $1500.00 | 1750521720 - SPOKANE VALLEY EAR NOSE & THROAT PS, SPOKANE VALLEY AMBULATORY SURGERY CENTER | 911072626 - (WA) SPOKANE VALLEY EAR, NOSE & THROAT, P.S. | WA | 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 28250 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 28250 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 28250 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 |
|---|---|---|
| 28240-CPT | Moderate | Tenotomy Abductor Hallucis Muscle |
| 28250-CPT | Moderate | Division Plantar Fascia And Muscle |
| 28260-CPT | Moderate | Capsulotomy Midfoot Medial Release |
| 28262-CPT | High | Capsulotomy, Midfoot; Extensive, Including Posterior Talotibial Capsulotomy And Tendon(S) Lengthening (Eg, Resistant Clubfoot Deformity) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 28250. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 28250 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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