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See a sample rate comparisonCPT 28270 Fee Schedule
Medicare rates as of October 2026
CPT 28270 is classified under Surgery, in the Surgical Procedures on the Musculoskeletal System subgroup.
Capsulotomy; Metatarsophalangeal Joint W//W/O Tenorrhaphy E, Capsulotomy; Metatarsophalangeal Joint With Or Without Tenorrhaphy E
| 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 | 59Distinct Procedural Service RTRight side of body |
| Hospital Outpatient Group (APC) | APC 5113 - Level 3 Musculoskeletal Procedures |
| Surgery Center Payment (ASC) | A2 - Paid separately, from the OPPS relative weight |
| Common Revenue Codes | 03600761Sign up to view all 9 |
| Medicare Fee Schedule | $488.66 national non-facility rate (2026)View Medicare rates for 28270 |
| Medicaid Fee Schedule | $383.595 median of the 8 states in the free previewView Medicaid rates for 28270 |
National average reimbursement for CPT 28270 by major payers:
$586.32
BCBS / Anthem
$641.85
UnitedHealthcare
$667.17
Aetna
$566.45
Cigna
Compare published rates across providers.
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CPT 28270
5 of 25 sample ratesHigher to lower in this preview
Physicians West Houston Surgical Center, LLC, Memorial Hermann Surgery Center Park Ten
$5,729.00Published rateThe Regents Of The University Of California, Ucla Dept Of Medicine
$2,044.00Published rateO'Fallon Surgical Center, LLC, Physicians Surgical Center
$1,377.00Published rateSpicewood Surgery Center LLC, Spicewood Surgery Center
Spicewood Surgery Center LLC
$1,072.50Published rateLiberty Endoscopy Center
Liberty Endoscopy Center, LLC
$814.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 28270 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The table lists codes related to 28270. Select one to see its fee schedule.
| Code | Description |
|---|---|
| 28264-CPT | Capsulotomy Midtarsal Heyman Type |
| 28270-CPT | Capsulotomy; Metatarsophalangeal Joint W//W/O Tenorrhaphy E, Capsulotomy; Metatarsophalangeal Joint With Or Without Tenorrhaphy E |
| 28272-CPT | Capsulotomy; Interphalang Joint Ea Joint (Sepa Proc), Capsulotomy; Interphalangeal Joint Each Joint (Separate Procedure) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 28270. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 28270 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 28270 assigned to?
Medicare's hospital outpatient payment system (OPPS) assigns CPT 28270 to APC 5113 (Level 3 Musculoskeletal Procedures). An APC groups outpatient services that Medicare pays at the same base rate.
How does Medicare pay for CPT 28270 in an ambulatory surgery center?
CMS lists CPT 28270 with ASC payment indicator A2: Paid separately, from the OPPS relative weight.
Which revenue codes are billed with CPT 28270?
Hospital price transparency files list CPT 28270 under these revenue codes: including 0360, 0761, 0960, 0361 and 0975. A revenue code names the hospital department or charge category for the line; it does not change what the service is.