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See a sample rate comparisonCPT 28296 Fee Schedule
Medicare rates as of October 2026
CPT 28296 is classified under Surgery, in the Surgical Procedures on the Musculoskeletal System subgroup.
Correction Hallux Valgus (Bun, Correction Hallux Valgus (Bunion) With Or Withoutsesamoidectomy With Metatarsal Osteotomy (Eg Mitchell Chevron Or Concentric Type Procedures)
| 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 |
| Add-on Codes | 20705 |
| Common Revenue Codes | 03600975Sign up to view all 8 |
| Medicare Fee Schedule | $883.45 national non-facility rate (2026)View Medicare rates for 28296 |
| Medicaid Fee Schedule | $694.49 median of the 8 states in the free previewView Medicaid rates for 28296 |
National average reimbursement for CPT 28296 by major payers:
$1,061.60
BCBS / Anthem
$1,115.19
UnitedHealthcare
$1,165.40
Aetna
$890.91
Cigna
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 28296.
CPT 28296
5 of 25 sample ratesHigher to lower in this preview
Texas Health Harris Methodist Hospital Azle
$11,871.00Published rateSurgery Center Of Scottsdale, LLC, Mountain View Surgery Center Of Scottsdale
Surgery Center Of Scottsdale LLC
$3,570.00Published rateTri City Surgery Center LLC
Tri-City Surgery Center LLC
$2,200.00Published ratePain Center Of Wyoming Valley, LLC
Pain Center Of Wyoming Valley LLC
$1,519.00Published rateTampa Surgery Center LLC
$899.00Published rate
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See a sample payer proposalCPT 28296 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The table lists codes related to 28296. Select one to see its fee schedule.
| Code | Description |
|---|---|
| 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 |
| 28298-CPT | Correction Hallux Valgus (Bunionectomy) With Sesamoidectomy When Perfomred; With Proximal Phalanx Osteotomy Any Method. (Desc Revised 1/1/2017) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 28296. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 28296 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?
The cost of a medical procedure can vary significantly based on your location, the specific provider, and your insurance plan. To get an estimate for a specific CPT code and your location, you can use tools like Payerprice. They offer a fee schedule lookup tool that allows you to search for prices based on CPT code and specific geographic area. It's also recommended to contact your insurance provider and the healthcare facility directly for the most accurate information tailored to your specific situation.
What is a CPT code and why is it important for understanding medical bills?
CPT stands for Current Procedural Terminology. CPT codes are a set of medical codes used by physicians, healthcare professionals, and payers to describe medical, surgical, and diagnostic services. They are crucial for understanding medical bills because they standardize the reporting of services, allowing for consistent billing and processing by insurance companies. Knowing the CPT codes for services you receive can help you verify the services billed and research their typical costs.
Where can I look up healthcare service prices in my area?
To look up healthcare service prices specific to your location and a particular CPT code, you can use specialized tools. Payerprice provides a fee schedule lookup tool designed for this purpose, allowing users to search with CPT codes and specific locations to find relevant pricing information. This can help you compare costs and make informed decisions about your healthcare.
What's the difference between what my doctor charges and what my insurance pays?
The amount your doctor charges (the 'billed charge') is often different from what your insurance actually pays (the 'allowed amount' or 'negotiated rate'). Insurance companies negotiate discounted rates with providers, and this negotiated rate is typically less than the billed charge. Your responsibility is usually based on this allowed amount, minus any deductibles, co-pays, or co-insurance. Tools like Payerprice can help you understand typical fee schedules, which can give insight into these allowed amounts for specific CPT codes in your area, though your specific insurance plan will dictate your exact out-of-pocket costs.
What APC is CPT 28296 assigned to?
Medicare's hospital outpatient payment system (OPPS) assigns CPT 28296 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 28296 in an ambulatory surgery center?
CMS lists CPT 28296 with ASC payment indicator A2: Paid separately, from the OPPS relative weight.
Which add-on codes are billed with CPT 28296?
CMS add-on code edits list CPT 28296 as a primary code for these add-on codes: 20705.
Which revenue codes are billed with CPT 28296?
Hospital price transparency files list CPT 28296 under these revenue codes: including 0360, 0975, 0960, 0490 and 0982. A revenue code names the hospital department or charge category for the line; it does not change what the service is.