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See a sample rate comparisonCPT 28272 Fee Schedule
Medicare rates as of October 2026
CPT 28272 is classified under Surgery, in the Surgical Procedures on the Musculoskeletal System subgroup.
Capsulotomy; Interphalang Joint Ea Joint (Sepa Proc), Capsulotomy; Interphalangeal Joint Each Joint (Separate Procedure)
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 11Office 24Ambulatory Surgical Center |
| Common Modifiers | 59Distinct Procedural Service T6Right foot, second digit |
| Hospital Outpatient Group (APC) | APC 5112 - Level 2 Musculoskeletal Procedures |
| Surgery Center Payment (ASC) | P3 - Office-based; paid from physician fee schedule practice expense |
| Common Revenue Codes | 03600361Sign up to view all 4 |
| Medicare Fee Schedule | $377.10 national non-facility rate (2026)View Medicare rates for 28272 |
| Medicaid Fee Schedule | $296.725 median of the 8 states in the free previewView Medicaid rates for 28272 |
National average reimbursement for CPT 28272 by major payers:
$497.68
BCBS / Anthem
$513.05
UnitedHealthcare
$513.34
Aetna
$624.32
Cigna
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 28272.
CPT 28272
5 of 25 sample ratesHigher to lower in this preview
Fairfax Surgical Center, L.P.
Fairfax Surgical Center Lp
$5,379.00Published rateCentral Maine Eye Surgery Center LLC
$2,388.00Published rateAuburn Surgery Center Inc.
Auburn Surgery Center Inc
$1,600.00Published rateAmerican Access Care Of Baltimore Asc LLC
$1,200.00Published rateSullivan Surgicenter,LLC
Sullivan Surgicenter LLC
$750.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 28272 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The table lists codes related to 28272. Select one to see its fee schedule.
| Code | Description |
|---|---|
| 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) |
| 28280-CPT | Webbing Operation For Soft Corn Kelikia |
| 28285-CPT | Correct Hammertoe (Eg Interphalang Fusion Partial Or Total Ph, Correction Hammertoe (Eg Interphalangeal Fusion Partial Or Total Ph |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 28272. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 28272 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 28272 assigned to?
Medicare's hospital outpatient payment system (OPPS) assigns CPT 28272 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 28272 in an ambulatory surgery center?
CMS lists CPT 28272 with ASC payment indicator P3: Office-based; paid from physician fee schedule practice expense.
Which revenue codes are billed with CPT 28272?
Hospital price transparency files list CPT 28272 under these revenue codes: 0360, 0361, 0761 and 0960. A revenue code names the hospital department or charge category for the line; it does not change what the service is.