CPT 28291 Fee Schedule
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.
| 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 | Moderate |
National average reimbursement for CPT 28291 by major payers:
$900.57
$1,005.87
$966.02
$1,191.23
| 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 28291 | ||||||
United | 28291 | $5841.00 | 1477516961 - CENTRUM SURGERY CENTER LTD | 752546712 - (CO) CENTRUM SURGERY CENTER LTD | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28291 | $1811.00 | 1841395621 - BERKELEY ENDOSCOPY CENTER LLC | 383712079 - (SC) BERKELEY ENDOSCOPY CENTER LLC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28291 | $6588.00 | 1558794081 - SURGERY CENTER OF SCOTTSDALE, LLC | 731553441 - (AZ) SURGERY CENTER OF SCOTTSDALE LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28291 | $5835.00 | 1932530284 - VP SURGERY CENTER OF AUBURN LLC | 371668651 - (WA) VP SURGERY CENTER OF AUBURN LLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28291 | $1064.00 | 1356383640 - SOUTHWESTERN EYE CENTER LTD, SOUTHWESTERN EYE CENTER | 860423068 - SOUTHWESTERN EYE CENTER, LTD. | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28291 | $6492.00 | 1295479780 - ADVENTHEALTH SURGERY CENTER DAVENPORT LLC | 881811228 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28291 | $1907.00 | 1871811257 - HILLSIDE ENDOSCOPY CENTER, LLC | 263741464 - (PA) HILLSIDE ENDOSCOPY CENTER LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28291 | $6365.00 | 1104181247 - ADVANCED SURGERY CENTER OF NORTHERN LOUISIANA LLC | 455502071 - (LA) ADVANCED SURGERY CENTER OF NORTHERN LOUISIANA, LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28291 | $4170.00 | 1285283432 - JONESBORO AMBULATORY SURGERY CENTER, LLC | 832479059 - (AR) JONESBORO AMBULATORY SURGERY CENTER LLC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28291 | $1503.00 | 1396733945 - EYE LASER & SURGERY CENTER OF COLUMBUS, LLC | 640942234 - (MS) EYE LASER SURGERY CENTER OF COLUMBUS LLC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28291 | $6824.00 | 1821194754 - COASTAL SURGICAL SPECIALISTS, INC. | 743000596 - (CA) COASTAL SURGICAL INSTITUTE | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28291 | $3985.00 | 1649252883 - FOUNDATION SURGERY AFFILIATE OF NACOGDOCHES LLC, NACOGDOCHES SURGERY CENTER | 731589339 - (TX) FOUNDATION SURGERY AFFILIATE OF NACOGDOCHES LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28291 | $3757.00 | 1477586063 - ATHENS ORTHOPEDIC CLINIC AMBULATORY SURGERY CENTER, LLC | 203378059 - (GA) ATHENS ORTHOPEDIC CLINIC AMBULATORY SURGERY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28291 | $6087.00 | 1063947422 - SILVER CROSS AMBULATORY SURGERY CENTER, LLC, SILVER CROSS SURGERY CENTER | 371852055 - (IL) SILVER CROSS AMBULATORY SURGERY CENTER LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28291 | $7621.00 | 1194935577 - MILLENNIUM SURGICAL CENTER LLC | 205225327 - (NJ) MILLENNIUM SURGICAL CENTER, LLC | NJ | 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 |
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CPT 28291 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 28291 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 28291 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 |
|---|---|---|
| 28289-CPT | Moderate | Hallux Rigidus Correction With Cheilectomy Debridement And Capsular Release Of The First Metatarsophalangeal Joint; Without Implant. (Desc Revised 1/1/2017) |
| 28291-CPT | Moderate | Once Per Dos Hallux Rigidus Correction With Cheilectomy, Debridement & Capsular Release Of First Metatarsophalangeal Joint; With Implant |
| 28292-CPT | Moderate | Correction Hallux Valgus (Bunionectomy) With Sesamoidectomy When Performed; With Resection Of Proximal Phalanx Base When Performed Any Method.(Desc Revised 1/1/2017) |
| 28309-CPT | High | Osteotomy, With Or Without Lengthening, Shortening Or Angular Correction, Metatarsal; Multiple (Eg, Swanson Type Cavus Foot Procedure) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 28291. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 28291 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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