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See a sample rate comparisonCPT 28292 Fee Schedule
Medicare rates as of October 2026
CPT 28292 is classified under Surgery, in the Surgical Procedures on the Musculoskeletal System subgroup.
Cor Hlx Vlgs Rsc Prx Phlx Bs, Correction Hallux Valgus With Bunionectomy With Sesamoidectomy When Performed With Resection Of Proximal Phalanx Base When Performed Any Method
| 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 | RTRight side of body LTLeft 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 | 03600975Sign up to view all 6 |
| Medicare Fee Schedule | $703.09 national non-facility rate (2026)View Medicare rates for 28292 |
| Medicaid Fee Schedule | $560.195 median of the 8 states in the free previewView Medicaid rates for 28292 |
National average reimbursement for CPT 28292 by major payers:
$891.48
BCBS / Anthem
$974.58
UnitedHealthcare
$1,003.31
Aetna
$856.10
Cigna
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 28292.
CPT 28292
5 of 25 sample ratesHigher to lower in this preview
Aurora Gi Asc LLC, Wisconsin Digestive Health Center
Aurora Gi Asc LLC
$9,159.00Published rateSummit Orthopedics Ltd, Eagan Surgery Center
Summit Orthopedics, Ltd.
$3,989.00Published rateAtlas Surgery Center, LLC, Atlas Surgery Center, LLC
Atlas Surgery Center LLC
$1,980.00Published rateSuburban Endoscopy Center, LLC, Suburban Endoscopy Center
Suburban Endoscopy Center LLC
$1,514.00Published rateSt Marks Surgical Center LLC
$601.00Published rate
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See a sample payer proposalCPT 28292 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The table lists codes related to 28292. Select one to see its fee schedule.
| Code | Description |
|---|---|
| 28291-CPT | Hallux Rigidus Correction With Cheilectomy Debridement, Hallux Rigidus Correction With Cheilectomy Debridement And Capsular Release Of The First Metatarsophalangeal Joint; With Implant |
| 28292-CPT | Cor Hlx Vlgs Rsc Prx Phlx Bs, Correction Hallux Valgus With Bunionectomy With Sesamoidectomy When Performed With Resection Of Proximal Phalanx Base When Performed Any Method |
| 28295-CPT | Cor Hlx Vlgs Prx Mtar Osteot, Correction Hallux Valgus With Bunionectomy With Sesamoidectomy When Performed With Proximal Metatarsal Osteotomy Any Method |
| 28299-CPT | Cor Hlx Vlgs Double Osteot, Correction Hallux Valgus With Bunionectomy With Sesamoidectomy When Performed With Double Osteotomy Any Method |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 28292. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 28292 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 28292 assigned to?
Medicare's hospital outpatient payment system (OPPS) assigns CPT 28292 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 28292 in an ambulatory surgery center?
CMS lists CPT 28292 with ASC payment indicator A2: Paid separately, from the OPPS relative weight.
Which revenue codes are billed with CPT 28292?
Hospital price transparency files list CPT 28292 under these revenue codes: including 0360, 0975, 0960, 0761 and 0490. A revenue code names the hospital department or charge category for the line; it does not change what the service is.