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See a sample rate comparisonCPT 28295 Fee Schedule
Medicare rates as of October 2026
CPT 28295 is classified under Surgery, in the Surgical Procedures on the Musculoskeletal System subgroup.
Cor Hlx Vlgs Prx Mtar Osteot, Correction Hallux Valgus With Bunionectomy With Sesamoidectomy When Performed With Proximal Metatarsal Osteotomy 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) | G2 - Paid separately, from the OPPS relative weight |
| Add-on Codes | 20705 |
| Common Revenue Codes | 03600960 |
| Medicare Fee Schedule | $1,065.16 national non-facility rate (2026)View Medicare rates for 28295 |
| Medicaid Fee Schedule | $832.545 median of the 8 states in the free previewView Medicaid rates for 28295 |
National average reimbursement for CPT 28295 by major payers:
$1,245.51
BCBS / Anthem
$1,333.94
UnitedHealthcare
$1,390.24
Aetna
$998.28
Cigna
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 28295.
CPT 28295
5 of 25 sample ratesHigher to lower in this preview
Surgery Affiliate Of El Paso, LLC, Foundation Surgery Affiliate Of El Paso, LLC
Surgery Affiliate Of El Paso LLC
$12,233.00Published rateStone Oak Surgicenter, LLC
$4,122.00Published rateLake Endoscopy Center, LLC
Lake Endoscopy Center LLC
$3,347.00Published rateNew Orleans La Uptown West Bank Endoscopy Asc LLC, Mga Gastrointestinal Diagnostic And Terapeutic Center
$1,546.00Published rateEyecare Surgery Center, LLC
Eyecare Surgery Center LLC
$793.00Published rate
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See a sample payer proposalCPT 28295 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The table lists codes related to 28295. Select one to see its fee schedule.
| Code | Description |
|---|---|
| 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 |
| 28296-CPT | Correction Hallux Valgus (Bun, Correction Hallux Valgus (Bunion) With Or Withoutsesamoidectomy With Metatarsal Osteotomy (Eg Mitchell Chevron Or Concentric Type Procedures) |
| 28297-CPT | Correction Hallux Valgus (Bun, Correction Hallux Valgus (Bunionectomy) With Sesamoidectomy When Performed With First Metatarsaland Medial Cuneiform Joint Arthrodesis Any Metho D |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 28295. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 28295 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 28295 assigned to?
Medicare's hospital outpatient payment system (OPPS) assigns CPT 28295 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 28295 in an ambulatory surgery center?
CMS lists CPT 28295 with ASC payment indicator G2: Paid separately, from the OPPS relative weight.
Which add-on codes are billed with CPT 28295?
CMS add-on code edits list CPT 28295 as a primary code for these add-on codes: 20705.
Which revenue codes are billed with CPT 28295?
Hospital price transparency files list CPT 28295 under these revenue codes: 0360 and 0960. A revenue code names the hospital department or charge category for the line; it does not change what the service is.