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See a sample rate comparisonCPT 28264 Fee Schedule
Last Verified: September 2026
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.
Capsulotomy Midtarsal Heyman Type
| 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 RT - Right side of body LT - Left side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 28264 |
| Medicaid Fee Schedule | View Medicaid rates for 28264 |
National average reimbursement for CPT 28264 by major payers:
$1,158.72
$1,262.74
$1,218.23
$1,162.58
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CPT 28264
5 of 25 sample ratesHigher to lower in this preview
San Antonio Surgery Center, The Center For Special Surgery @ Tca
$7,319.00Published rateCenter For Ambulatory Surgery, LLC, The Center For Ambulatory Surgery
The Center For Ambulatory Surgery LLC
$4,601.00Published rateCleveland Clinic Florida (A Nonprofit Corporation), Cleveland Clinic Florida Coral Springs Asc
Cleveland Clinic Florida A Nonprofit Corporation
$2,945.00Published rateAndrew Houseman
Deaconess Hospital Inc
$1,765.70Published rateMesquite Surgery Center LLC
Mesquite Surgery Center, LLC
$749.00Published rate
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See a sample payer proposalCPT 28264 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 28264 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 28264 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 |
|---|---|---|
| 28261-CPT | High | Release Mid-Foot Restriction, Surgery To Release Mid-Foot Contracture By Cutting The Capsule That Encases The Foot Joint. |
| 28262-CPT | High | Revision Of Foot And Ankle, Capsulotomy Midfoot Extensive Including Posterior Talotibial Capsulotomy And Tendon S Lengthening Eg Resistant Clubfoot Deformity |
| 28264-CPT | High | Capsulotomy Midtarsal Heyman Type |
| 28280-CPT | Moderate | Webbing Operation For Soft Corn Kelikia |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 28264. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 28264 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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