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See a sample rate comparisonCPT 28270 Fee Schedule
Last Verified: September 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
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 | 24 - Ambulatory Surgical Center 22 - On Campus Outpatient Hospital |
| Common Modifiers | 59 - Distinct Procedural Service None RT - Right side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 28270 |
| Medicaid Fee Schedule | View Medicaid rates for 28270 |
National average reimbursement for CPT 28270 by major payers:
$586.32
$641.85
$667.17
$566.45
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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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See a sample payer proposalCPT 28270 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 28270 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 28270 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 |
|---|---|---|
| 28264-CPT | High | Capsulotomy Midtarsal Heyman Type |
| 28270-CPT | Moderate | Capsulotomy; Metatarsophalangeal Joint W//W/O Tenorrhaphy E, Capsulotomy; Metatarsophalangeal Joint With Or Without Tenorrhaphy E |
| 28272-CPT | Moderate | 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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