CPT 28296 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 28296 |
National average reimbursement for CPT 28296 by major payers:
$1,061.60
$1,115.19
$1,165.40
$1,418.80
| 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 28296 | ||||||
United | 28296 | $3570.00 | 1881969269 - SURGERY CENTRE OF SW FLORIDA LLC, CAPE HEALTH SURGERY CENTER | 454068750 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28296 | $1519.00 | 1629409578 - PAIN CENTER OF WYOMING VALLEY, LLC | 462023592 - (PA) PAIN CENTER OF WYOMING VALLEY LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28296 | $2080.00 | 1417409285 - BEAUMONT ASC, LP, BEAUMONT HEART & VASCULAR SURGERY CENTER | 814050976 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28296 | $3623.00 | 1750823886 - LAKE ENDOSCOPY CENTER, LLC | 814225104 - (FL) LAKE ENDOSCOPY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28296 | $1632.03 | 1861840779 - JESSICA TRIMER | 350593390 - DEACONESS HOSPITAL INC | WV | Certified Registered Nurse Anesthetist (367500000X) |
United | 28296 | $2200.00 | 1437101433 - TRI CITY SURGERY CENTER LLC | 201504745 - (AZ) TRI-CITY SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28296 | $1632.03 | 1316106685 - CHRISTOPHER KATCHERIAN | 350593390 - DEACONESS HOSPITAL INC | IA | Orthopaedic Hand Surgery Physician (207XS0106X) |
United | 28296 | $1452.00 | 1548216914 - UPPER CUMBERLAND PHYSICIANS SURGERY CENTER LLC | 450470832 - (TN) UPPER CUMBERLAND PHYSICIANS SURGERY CENTER LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28296 | $1144.00 | 1306938550 - WEST GEORGIA ENDOSCOPY CENTER | 753182533 - (GA) WEST GEORGIA ENDOSCOPY CENTER | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28296 | $899.00 | 1023256187 - TAMPA SURGERY CENTER LLC | 264008716 - (FL) TAMPA SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28296 | $3570.00 | 1902807159 - SURGERY CENTER OF SCOTTSDALE, LLC, MOUNTAIN VIEW SURGERY CENTER OF SCOTTSDALE | 731553441 - (AZ) SURGERY CENTER OF SCOTTSDALE LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28296 | $1100.00 | 1457813107 - SURGEON'S SURGERY CENTER SORELLE PLLC | 831414422 - (NV) SURGEONS SURGERY CENTER SORELLE PLLC | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28296 | $3347.00 | 1861740508 - ADVANCED SURGERY CENTER OF SARASOTA, LLC | 454909647 - (FL) ADVANCED SURGERY CENTER OF SARASOTA LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28296 | $11871.00 | 1154454205 - TEXAS HEALTH HARRIS METHODIST HOSPITAL AZLE | 751748586 - (TX) TEXAS HEALTH HARRIS METHODIST HOSPITAL AZLE | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28296 | $2703.00 | 1366041469 - THE REGENTS OF THE UNIVERSITY OF CALIFORNIA | 954373071 | CA | 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 28296 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 28296 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 28296 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 |
|---|---|---|
| 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) |
| 28298-CPT | Moderate | 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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