CPT 28262 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 | • 22 - On Campus Outpatient Hospital • 21 - Inpatient Hospital |
| Common Modifiers | • None • LT - Left side of body • RT - Right side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 28262 |
National average reimbursement for CPT 28262 by major payers:
$1,808.28
$1,862.48
$1,953.31
$2,298.57
| 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 28262 | ||||||
United | 28262 | $1072.50 | 1497895361 - MADHU K. KRIS M.D., MERCED AMBULATORY ENDOSCOPY CENTER | 770095000 - (CA) MADHU K KRIS MD | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28262 | $1317.00 | 1093748527 - WOODHAMS LASER & LENS IMPLANT CENTER LLC | 582631668 - (GA) WOODHAMS LASER LENS IMPLANT CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28262 | $730.00 | 1073581880 - AMBULATORY SURGERY CENTER LLC, THE CENTER FOR SAME DAY SURGERY | 481114690 - (KS) AMBULATORY SURGERY CENTER, LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28262 | $1072.50 | 1417409285 - BEAUMONT ASC, LP, BEAUMONT HEART & VASCULAR SURGERY CENTER | 814050976 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28262 | $867.00 | 1821064031 - PIEDMONT DAY SURGERY CENTER INC | 541514162 | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28262 | $908.00 | 1043497019 - PIKESVILLE MD ENDOSCOPY ASC LLC, ENDOCENTRE OF BALTIMORE | 261467040 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28262 | $1450.00 | 1891722609 - EYE MDS OF PUGET SOUND PLLC, NARROWS EYE SURGERY CENTER | 43700768 - (WA) EYE M.D.S OF PUGET SOUND, PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28262 | $3871.00 | 1417534207 - MEDICAL CITY SURGERY CENTER OF FRISCO, LLC | 822432064 - (TX) MEDICAL CITY SURGERY CENTER OF FRISCO LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28262 | $380.00 | 1265434740 - SALLY K BALIN AMBULATORY SURGICAL CENTER INC | 232969046 - (PA) SALLY K BALIN AMBULATORY SURGICAL CENTER INC. | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28262 | $4617.00 | 1336695188 - HHC HARTFORD SURGERY CENTER, LLC | 812637261 - (CT) HHC HARTFORD SURGERY CENTER, LLC | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28262 | $940.00 | 1720262405 - BATON ROUGE LA ENDOSCOPY ASC LLC, LOUISIANA ENDOSCOPY CENTER | 261168310 | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28262 | $1516.00 | 1396709077 - RMC SURGERY CENTER, LLC, RMC SURGERY CENTER | 330937423 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28262 | $1600.00 | 1437894276 - GEORGIA INTERVENTIONAL PAIN | 872711994 - (GA) GEORGIA INTERVENTIONAL PAIN | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28262 | $1260.00 | 1063733095 - WOLFE SURGERY CENTER, LLC | 272625124 - (IA) WOLFE SURGERY CENTER LLC | IA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28262 | $1000.00 | 1326512070 - RICHFIELD SURGERY CENTER, LLC | 825304896 | UT | 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 28262 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 28262 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 28262 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 |
|---|---|---|
| 28260-CPT | Moderate | Capsulotomy Midfoot Medial Release |
| 28261-CPT | High | Capsulot Midfoot W Tendon Lengthen |
| 28262-CPT | High | Capsulotomy, Midfoot; Extensive, Including Posterior Talotibial Capsulotomy And Tendon(S) Lengthening (Eg, Resistant Clubfoot Deformity) |
| 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 28262. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 28262 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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