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See a sample rate comparisonCPT 28297 Fee Schedule
Medicare rates as of October 2026
CPT 28297 is classified under Surgery, in the Surgical Procedures on the Musculoskeletal System subgroup.
Correction Hallux Valgus (Bun, Correction Hallux Valgus (Bunionectomy) With Sesamoidectomy When Performed With First Metatarsaland Medial Cuneiform Joint Arthrodesis Any Metho D
| 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 5115 - Level 5 Musculoskeletal Procedures |
| Surgery Center Payment (ASC) | J8 - Device-intensive procedure, paid at an adjusted rate |
| Common Revenue Codes | 03600975Sign up to view all 6 |
| Medicare Fee Schedule | $1,030.75 national non-facility rate (2026)View Medicare rates for 28297 |
| Medicaid Fee Schedule | $807.46 median of the 8 states in the free previewView Medicaid rates for 28297 |
National average reimbursement for CPT 28297 by major payers:
$1,134.20
BCBS / Anthem
$1,269.60
UnitedHealthcare
$1,336.91
Aetna
$1,022.67
Cigna
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 28297.
CPT 28297
5 of 25 sample ratesHigher to lower in this preview
Holly Springs Surgery Center, LLC
Holly Springs Surgery Center LLC
$4,728.00Published rateSummit Ambulatory Surgical Center, LLC
$3,500.00Published rateAbilene Surgery Center, LLC
Abilene Surgery Center LLC
$2,010.00Published rateColumbia Nephrology Associates PA
The Columbia Nephrology Associates, P.A.
$1,500.00Published rateForest Canyon Endoscopy & Surgery Ctr PC
Forest Canyon Endoscopy & Surgery Center, PC
$886.00Published rate
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See a sample payer proposalCPT 28297 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The table lists codes related to 28297. 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 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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Frequently Asked Questions
What is a CPT code?
CPT stands for Current Procedural Terminology. CPT codes are standardized five-digit numeric codes used by healthcare providers to describe medical, surgical, and diagnostic services to payers for billing purposes. They are essential for accurate communication and processing of claims.
How can I find the cost of a specific medical procedure?
The cost of medical procedures can vary significantly based on factors like your location, the specific healthcare provider, and your insurance plan. To find specific fee schedule information for a particular CPT code and your location, it is recommended to use a specialized tool like Payerprice. Payerprice offers a fee schedule lookup tool designed for users to search with CPT codes and specific locations.
What is Payerprice?
Payerprice is a service that provides a fee schedule lookup tool. It allows users to search for the cost of medical procedures using CPT codes and specific geographical locations, helping them understand potential healthcare costs and negotiate prices.
Why should I use Payerprice instead of CMS for fee schedule lookups?
While CMS (Centers for Medicare & Medicaid Services) provides information primarily related to Medicare and Medicaid reimbursement rates, Payerprice offers a broader fee schedule lookup tool. It allows users to search specifically with CPT codes and their location to get more general or commercial payer fee schedule information, which can be more relevant for individuals with private insurance or those looking for a broader market comparison beyond government programs.
What information do I need to use Payerprice's lookup tool?
To effectively use Payerprice's fee schedule lookup tool, you typically need the CPT (Current Procedural Terminology) code for the medical service or procedure you are interested in, along with your specific geographical location (e.g., zip code or city/state).
What APC is CPT 28297 assigned to?
Medicare's hospital outpatient payment system (OPPS) assigns CPT 28297 to APC 5115 (Level 5 Musculoskeletal Procedures). An APC groups outpatient services that Medicare pays at the same base rate.
How does Medicare pay for CPT 28297 in an ambulatory surgery center?
CMS lists CPT 28297 with ASC payment indicator J8: Device-intensive procedure, paid at an adjusted rate.
Which revenue codes are billed with CPT 28297?
Hospital price transparency files list CPT 28297 under these revenue codes: including 0360, 0975, 0960, 0490 and 0361. A revenue code names the hospital department or charge category for the line; it does not change what the service is.