CPT 28295 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address high-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 | High |
| Medicare Fee Schedule | View Medicare rates for 28295 |
National average reimbursement for CPT 28295 by major payers:
$1,245.51
$1,333.94
$1,390.24
$1,686.58
| 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 28295 | ||||||
United | 28295 | $6410.00 | 1740236454 - PRINCESS ANNE AMBULATORY SURGERY MANAGEMENT LLC, PRINCESS ANNE AMBULATORY SURGERY CENTER | 204920880 - (VA) PRINCESS ANNE AMBULATORY SURGERY MANAGEMENT, LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28295 | $1598.00 | 1053496240 - OAKLAND CA ENDOSCOPY ASC LP, EAST BAY ENDOSURGERY CENTER | 205645928 - (CA) OAKLAND CA ENDOSCOPY ASC LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28295 | $12233.00 | 1881678662 - SURGERY AFFILIATE OF EL PASO, LLC, FOUNDATION SURGERY AFFILIATE OF EL PASO, LLC | 742797719 - (TX) SURGERY AFFILIATE OF EL PASO LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28295 | $895.00 | 1568445062 - EYE SURGERY & LASER CENTER OF WISCONSIN LLC | 461222222 | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28295 | $4339.00 | 1891253035 - ADVANCED CENTER FOR SURGERY, THE ADVANCED CENTER FOR SURGERY | 611917634 - (FL) ADVANCED CENTER FOR SURGERY | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28295 | $3570.00 | 1104082692 - OLD TESSON SURGERY CENTER, L.P., OLD TESSON SURGERY CENTER | 262876334 - (MO) OLD TESSON SURGERY CENTER LP | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28295 | $837.00 | 1720268279 - PEARL ROAD SURGERY CENTER, LLC | 260812886 - (OH) PEARL ROAD SURGERY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28295 | $1906.00 | 1043845340 - NORTHEAST ENDOSCOPY LLC | 824889052 - (NY) NORTHEAST ENDOSCOPY LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28295 | $1128.00 | 1386793370 - SURGERY CENTER OF WEST MONROE, LLC | 721509507 | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28295 | $1546.00 | 1780865634 - NEW ORLEANS LA UPTOWN WEST BANK ENDOSCOPY ASC LLC, MGA GASTROINTESTINAL DIAGNOSTIC AND TERAPEUTIC CENTER | 205904530 | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28295 | $3347.00 | 1750823886 - LAKE ENDOSCOPY CENTER, LLC | 814225104 - (FL) LAKE ENDOSCOPY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28295 | $4633.00 | 1205327277 - AUSTIN GI SURGICENTER, LLC, AUSTIN ENDOSCOPY CENTER | 301073754 - (TX) AUSTIN GI SURGICENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28295 | $3570.00 | 1821342858 - SURGCENTER OF ORANGE PARK, LLC, ORANGE PARK ENDOSCOPY CENTER | 460858710 - (FL) SURGCENTER OF ORANGE PARK LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28295 | $2309.00 | 1982975959 - ARCHIBALD SURGERY CENTER, LLC | 453730425 - (CA) ARCHIBALD SURGERY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28295 | $1427.00 | 1609568922 - BETHESDA ENDOSCOPY CENTER, LLC | 521915901 - (MD) BETHESDA ENDOSCOPY CENTER LLC | MD | 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 28295 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 28295 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 28295 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 |
|---|---|---|
| 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) |
| 28295-CPT | High | Correction Hallux Valgus With Bunionectomy With Seasmoidectomy When Performed; With Proximal Metatarsal Osteotomy Any Method (Desc Rvsd 1/1/2024) |
| 28296-CPT | High | Correction Hallux Valgus (Bunionectomy) With Sesamoidectomy When Perfomred; With Distal Metatarsal Osteotomy Any Method. (Desc Revised 1/1/2017) |
| 28297-CPT | High | Correction Hallux Valgus With Bunionectomy With Sesamoidectomy When Perfomred; With First Metatarsal And Medial Cuneiform Joint Arthrodesis Any Method. (Desc Rvsd 1/1/2024) |
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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