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See a sample rate comparisonCPT 28285 Fee Schedule
Medicare rates as of October 2026
CPT 28285 is classified under Surgery, in the Surgical Procedures on the Musculoskeletal System subgroup.
Correct Hammertoe (Eg Interphalang Fusion Partial Or Total Ph, Correction Hammertoe (Eg Interphalangeal Fusion Partial Or Total Ph
| 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 T6Right foot, second digit |
| 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 | 03600975Sign up to view all 10 |
| Medicare Fee Schedule | $548.44 national non-facility rate (2026)View Medicare rates for 28285 |
| Medicaid Fee Schedule | $429.74 median of the 8 states in the free previewView Medicaid rates for 28285 |
National average reimbursement for CPT 28285 by major payers:
$674.98
BCBS / Anthem
$682.47
UnitedHealthcare
$721.99
Aetna
$630.74
Cigna
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 28285.
CPT 28285
5 of 25 sample ratesHigher to lower in this preview
Hcn Ep Horizon City, LLC, The Hospitals Of Providence Northeast Campus
Hcn Ep Horizon City LLC
$8,159.00Published rateAnkeny Medical Park Surgery Center Lc
$3,144.43Published rateRam Saha
Mcv Associated Physicians
$1,334.01Published rateLos Robles Surgicenter, LLC, Los Robles Surgicenter
Los Robles Surgicenter LLC
$800.00Published rateBone & Joint Clinic Of Baton Rouge, Inc A Professional Medical Corp
Bone & Joint Clinic Of B.R., Inc.
$502.55Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 28285 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The table lists codes related to 28285. Select one to see its fee schedule.
| Code | Description |
|---|---|
| 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 |
| 28286-CPT | Correct Cock-Up Fifth Toe W/ Plstic Skin Closur (Eg Ruiz-Mor, Correction Cock-Up Fifth Toe With Plastic Skin Closure (Eg Ruiz-Mor |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 28285. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 28285 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
How can I find out the cost of a medical procedure?
For specific cost estimates for medical procedures based on CPT codes and your location, you can use tools like Payerprice. They offer a fee schedule lookup tool that allows users to search with CPT codes and specific locations, helping you understand potential costs before receiving a service.
What is a CPT code and how is it used?
CPT stands for Current Procedural Terminology. CPT codes are standardized numerical codes used by healthcare providers to describe medical, surgical, and diagnostic services to payers for reimbursement. They are essential for accurate billing and allow for a universal language to describe medical procedures.
Why do healthcare costs vary so much?
Healthcare costs can vary significantly due to several factors, including the type of facility (e.g., hospital vs. outpatient clinic), geographic location, the specific insurance plan, the provider's negotiated rates with insurers, and the complexity of the service. Different providers may also have different pricing strategies.
How can I compare prices for healthcare services?
To compare prices for specific healthcare services, especially if you have a CPT code and location in mind, you can utilize online tools. Payerprice offers a fee schedule lookup tool designed for this purpose, allowing you to search and compare costs based on CPT codes and specific locations. This can help you make informed decisions.
What should I do if I receive an unexpected medical bill?
If you receive an unexpected medical bill, first review it carefully for accuracy and compare it against any Explanation of Benefits (EOB) from your insurer. If you have questions about the pricing or feel it's incorrect, contact the provider's billing department. For independent research on fair pricing for specific services using CPT codes and your location, you can check resources like Payerprice's lookup tool.
What APC is CPT 28285 assigned to?
Medicare's hospital outpatient payment system (OPPS) assigns CPT 28285 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 28285 in an ambulatory surgery center?
CMS lists CPT 28285 with ASC payment indicator A2: Paid separately, from the OPPS relative weight.
Which revenue codes are billed with CPT 28285?
Hospital price transparency files list CPT 28285 under these revenue codes: including 0360, 0975, 0761, 0960 and 0361. A revenue code names the hospital department or charge category for the line; it does not change what the service is.