CPT 28297 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 28297 |
National average reimbursement for CPT 28297 by major payers:
$1,134.20
$1,269.60
$1,336.91
$1,626.40
| 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 28297 | ||||||
United | 28297 | $1898.00 | 1285381004 - THE NEBRASKA AMBULATORY SURGICAL CENTER, LLC, THE NEBRASKA AMBULATORY SURGICAL CENTER | 872477902 - (NE) THE NEBRASKA AMBULATORY SURGICAL CENTER LLC | NE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28297 | $3570.00 | 1588260343 - ADVENTHEALTH SURGERY CENTER WELLSWOOD LLC, ADVENTHEALTH SURGERY CENTER WELLSWOOD | 854111089 - (FL) ADVENTHEALTH SURGERY CENTER WELLSWOOD LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28297 | $1635.00 | 1447385158 - HARBIN CLINIC, LLC, HARBIN GI | 582234927 - (GA) THE HARBIN CLINIC, L.L.C. | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28297 | $1763.00 | 1114491073 - ASC DEVELOPMENT COMPANY LLC | 203405773 - (MD) ASC DEVELOPMENT COMPANY LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28297 | $2100.00 | 1285675678 - FULLERTON SURGERY CENTER LTD, FULLERTON SURGERY CENTER INC | 200186328 - (IL) FULLERTON SURGERY CENTER LTD | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28297 | $3347.00 | 1720085277 - ROSWELL SURGERY CENTER LLC, ROSWELL SURGERY CENTER | 582577112 - (GA) ROSWELL SURGERY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28297 | $3570.00 | 1083938765 - MEDICAL PARK TOWER SURGERY CENTER, LLC, MEDICAL PARK TOWER SURGERY CENTER | 270543475 - (TX) MEDICAL PARK TOWER SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28297 | $1500.00 | 1760991921 - COLUMBIA NEPHROLOGY ASSOCIATES PA | 570702722 - (SC) THE COLUMBIA NEPHROLOGY ASSOCIATES, P.A. | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28297 | $3570.00 | 1891253035 - ADVANCED CENTER FOR SURGERY, THE ADVANCED CENTER FOR SURGERY | 611917634 - (FL) ADVANCED CENTER FOR SURGERY | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28297 | $1387.00 | 1982105458 - HEART CARE CENTER, LLC | 824195385 | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28297 | $2010.00 | 1033375399 - ABILENE SURGERY CENTER, LLC | 208816729 - (TX) ABILENE SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28297 | $4500.00 | 1184316432 - PRISMA HEALTH AMBULATORY SURGERY CENTERS-MIDLANDS, LLC | 582296052 - (SC) PRISMA HEALTH-MIDLANDS | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28297 | $2328.00 | 1144499633 - FOOTHILL SURGERY CENTER LP | 510453471 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28297 | $4728.00 | 1386190957 - HOLLY SPRINGS SURGERY CENTER, LLC | 473460976 - (NC) HOLLY SPRINGS SURGERY CENTER LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28297 | $1573.00 | 1235240813 - NORTH MISSISSIPPI AMBULATORY SURGERY CENTER LLC | 200145190 - (MS) NORTH MISSISSIPPI AMBULATORY SURGERY CENTER LLC | MS | 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 28297 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 28297 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 28297 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 28297. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 28297 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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