CPT 28264 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 | • 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 |
National average reimbursement for CPT 28264 by major payers:
$1,158.72
$1,262.74
$1,218.23
$1,488.52
| 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 28264 | ||||||
United | 28264 | $4992.00 | 1962431197 - SHAWNEE MISSION SURGERY CENTER LLC, ADVENTHEALTH SURGERY CENTER SHAWNEE MISSION | 481243914 - (KS) SHAWNEE MISSION SURGERY CENTER LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28264 | $997.00 | 1003816307 - SAGAMORE SURGICAL SERVICES, INC. | 351850819 - (IN) SAGAMORE SURGICAL SERVICES, INC. | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28264 | $5354.00 | 1871751859 - WESTMINSTER SURGERY CENTER | 262059600 - (MD) WESTMINSTER SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28264 | $3003.00 | 1467979443 - MVH ENDOSCOPY LLC, PCS ENDOSCOPY SUITE | 822606374 - (ID) MVH ENDOSCOPY LLC | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28264 | $1072.50 | 1194959809 - BEVERLY HILLS REGIONAL SURGERY CENTER LP | 263718069 - (CA) BEVERLY HILLS REGIONAL SURGERY CENTER LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28264 | $3973.00 | 1669895512 - AMBULATORY SURGICAL CENTER OF SOMERVILLE LLC, SOMERSET AMBULATORY SURGICAL CENTER | 371743209 | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28264 | $811.27 | 1124526611 - KATHLEEN QUATRO | 350593390 - DEACONESS HOSPITAL INC | KY | Family Nurse Practitioner (363LF0000X) |
United | 28264 | $2163.00 | 1871591248 - NOVAMED SURGERY CENTER OF NASHUA, LLC, NASHUA EYE SURGERY CENTER | 770618679 - (NH) NOVAMED SURGERY CENTER OF NASHUA LLC | NH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28264 | $7319.00 | 1801854591 - SAN ANTONIO SURGERY CENTER, THE CENTER FOR SPECIAL SURGERY @ TCA | 300796793 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28264 | $5433.00 | 1194723981 - GREENWOOD ASC LLC, GREENWOOD AMBULATORY SURGERY CENTER | 331021175 - (CO) GREENWOOD ASC LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28264 | $1765.70 | 1558352021 - ANDREW HOUSEMAN | 350593390 - DEACONESS HOSPITAL INC | IN | Emergency Medicine Physician (207P00000X) |
United | 28264 | $4601.00 | 1427049352 - CENTER FOR AMBULATORY SURGERY, LLC, THE CENTER FOR AMBULATORY SURGERY | 223638149 - (NJ) THE CENTER FOR AMBULATORY SURGERY LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28264 | $5354.00 | 1790104248 - METRO SURGERY CENTER, LLC, METRO SURGERY CENTER, LP | 810587498 - (AZ) METRO SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28264 | $2933.00 | 1508169921 - SAINT LUKES-GI DIAGNOSTICS LLC | 274142549 - (MO) SAINT LUKESGI DIAGNOSTICS LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28264 | $3877.00 | 1669079992 - WOODBURY SURGERY CENTER, LLC | 853366699 - (MN) WOODBURY SURGERY CENTER LLC | MN | 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 |
Want to see your competitors' rates?
Start your trial today to unlock complete access to provider rates and fee schedules in your area.
Here's what you can do with PayerPrice
Renegotiate your managed care contracts
Benchmark your current rates against market averages to identify opportunities for rate optimization.
Prospect for new business using fee schedules
Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.
Integrate real-time payer data into your workflows
Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.
PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.
CPT 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 | 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 |
| 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.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 28264) and we'll show you how you compare in 15 minutes or less.