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See a sample rate comparisonCPT 28264 Fee Schedule
Medicare rates as of October 2026
CPT 28264 is classified under Surgery, in the Surgical Procedures on the Musculoskeletal System subgroup.
Capsulotomy Midtarsal Heyman Type
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 24Ambulatory Surgical Center 22On Campus Outpatient Hospital |
| Common Modifiers | RTRight side of body LTLeft side of body |
| Hospital Outpatient Group (APC) | APC 5112 - Level 2 Musculoskeletal Procedures |
| Surgery Center Payment (ASC) | A2 - Paid separately, from the OPPS relative weight |
| Common Revenue Codes | 0360 |
| Medicare Fee Schedule | $959.61 national non-facility rate (2026)View Medicare rates for 28264 |
| Medicaid Fee Schedule | $742.305 median of the 8 states in the free previewView Medicaid rates for 28264 |
National average reimbursement for CPT 28264 by major payers:
$1,158.72
BCBS / Anthem
$1,262.74
UnitedHealthcare
$1,218.23
Aetna
$1,162.58
Cigna
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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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Payer Contract Negotiation
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See a sample payer proposalCPT 28264 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The table lists codes related to 28264. Select one to see its fee schedule.
| Code | Description |
|---|---|
| 28261-CPT | Release Mid-Foot Restriction, Surgery To Release Mid-Foot Contracture By Cutting The Capsule That Encases The Foot Joint. |
| 28262-CPT | Revision Of Foot And Ankle, Capsulotomy Midfoot Extensive Including Posterior Talotibial Capsulotomy And Tendon S Lengthening Eg Resistant Clubfoot Deformity |
| 28264-CPT | Capsulotomy Midtarsal Heyman Type |
| 28280-CPT | 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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Frequently Asked Questions
What APC is CPT 28264 assigned to?
Medicare's hospital outpatient payment system (OPPS) assigns CPT 28264 to APC 5112 (Level 2 Musculoskeletal Procedures). An APC groups outpatient services that Medicare pays at the same base rate.
How does Medicare pay for CPT 28264 in an ambulatory surgery center?
CMS lists CPT 28264 with ASC payment indicator A2: Paid separately, from the OPPS relative weight.
Which revenue codes are billed with CPT 28264?
Hospital price transparency files list CPT 28264 under these revenue codes: 0360. A revenue code names the hospital department or charge category for the line; it does not change what the service is.