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 |
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 | $425.00 | 1164488219 - ENDOSCOPY CENTER OF NORTHEAST TENNESSEE, PC | 621508557 | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28297 | $5852.00 | 1235715996 - CENTRAL UTAH SURGICENTER, LLC | 862348485 - (UT) CENTRAL UTAH SURGICENTER LLC | UT | 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 | $3500.00 | 1871751859 - WESTMINSTER SURGERY CENTER | 262059600 - (MD) WESTMINSTER SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28297 | $6600.00 | 1487933172 - MT. SCOTT SURGERY CENTER, LLC | 832600045 | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28297 | $897.00 | 1083638647 - WEST DES MOINES AMBULATORY SURGICAL CENTER LLC, WESTOWN AMBULATORY CENTER | 421469883 - (IA) WEST DES MOINES AMBULATORY SURGICAL CENTER LLC | IA | 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 | $1160.00 | 1841395621 - BERKELEY ENDOSCOPY CENTER LLC | 383712079 - (SC) BERKELEY ENDOSCOPY CENTER LLC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28297 | $4600.00 | 1316359532 - LONE STAR ENDOSCOPY CENTER, LLC | 273635726 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28297 | $1998.00 | 1003420001 - ON BEACH SURGERY CENTER, LLC | 831603088 - (CA) ON BEACH SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28297 | $1889.00 | 1386858595 - ALDERWOOD SURGERY CENTER LLC | 204979154 - (WA) ALDERWOOD SURGICAL CENTER | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28297 | $2990.00 | 1699818237 - BON SECOURS SURGERY CENTER AT VIRGINIA BEACH LLC, BON SECOURS SURGERY CENTER AT VIRGINIA BEACH | 203471584 - (VA) BON SECOURS SURGERY CENTER AT VIRGINIA BEACH LLC | VA | 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 | $1980.00 | 1760616031 - BLAINE MN MULTI SPECIALTY ASC LLC, NORTH METRO SURGERY CENTER | 262868539 - (MN) BLAINE MN MULTI SPECIALTY ASC LLC | MN | 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 | 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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