CPT 28304 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 | • 22 - On Campus Outpatient Hospital • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • LT - Left side of body • RT - Right side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 28304 |
National average reimbursement for CPT 28304 by major payers:
$1,048.82
$1,073.98
$1,154.33
$1,350.44
| 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 28304 | ||||||
United | 28304 | $1556.00 | 1578745568 - THE ENDOSCOPY CENTER OF WEST CENTRAL OHIO, LLC | 260251730 - (OH) THE ENDOSCOPY CENTER OF WEST CENTRAL OHIO LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28304 | $7621.00 | 1033373691 - THE SOUTHEASTERN SPINE INSTITUTE AMBULATORY SURGERY CENTER, LLC | 208037589 - (SC) THE SOUTHEASTERN SPINE INSTITUTE AMBULATORY SURGERY CENTER LLC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28304 | $1563.00 | 1255394771 - DOCTORS HOSPITAL SURGERY CENTER, L.P. | 861072579 - (GA) DOCTORS HOSPITAL SURGERY CENTER LP | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28304 | $5797.00 | 1134126097 - PHYSICIAN'S SURGERY CENTER OF KNOXVILLE LLC | 621777892 - (TN) PHYSICIANS SURGERY CENTER OF KNOXVILLE LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28304 | $2340.00 | 1326551623 - UNITED VASCULAR OF OMAHA LLC | 822359316 - (NE) UNITED VASCULAR OF OMAHA LLC | NE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28304 | $1486.00 | 1811059306 - PENINSULA EYE CENTER, P.A, PENINSULA CATARACT & LASER CENTER | 520974706 - (MD) PENINSULA EYE CENTER PA | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28304 | $1495.00 | 1639386659 - MIDWEST EYE CONSULTANTS, P.C., CLI SURGERY CENTER | 351845786 - (IN) MIDWEST EYE CONSULTANTS, P.C. | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28304 | $2065.00 | 1366761397 - MEDINA-SUMMIT AMBULATORY SURGERY CENTER, THE MEDINA SURGERY CENTER | 261421110 - (OH) SUMMA HEALTH, PENSION ADMINISTATION COMMITTEE | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28304 | $4327.00 | 1790167740 - TIDALHEALTH SURGERY CENTER, LLC | 474184623 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28304 | $3200.00 | 1932309341 - HERNDON SURGERY CENTER, INC. | 461297783 - (CA) FRESNO CA MULTI ASC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28304 | $3900.00 | 1316603699 - HEATHROW SURGERY CENTER LLC | 851780627 - (FL) HEATHROW SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28304 | $5000.00 | 1356718514 - WACO AMBULATORY SURGERY CENTER, LP, WACO CARDIOLOGY CATH LAB & SURGERY CENTER | 473337811 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28304 | $7888.00 | 1912434697 - SUMMIT AMBULATORY SURGICAL CENTER, LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28304 | $4842.00 | 1770958522 - UCHEALTH AMBULATORY SURGERY CENTERS, LONGS PEAK SURGERY CENTER, LLC | 383984888 - (CO) UCHEALTH AMBULATORY SURGERY CENTERS | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28304 | $1861.00 | 1942353115 - SOUTHERN CRESCENT PLASTIC SURGERY ASC | 582093063 | GA | 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 28304 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 28304 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 28304 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 |
|---|---|---|
| 28261-CPT | High | Capsulot Midfoot W Tendon Lengthen |
| 28262-CPT | High | Capsulotomy, Midfoot; Extensive, Including Posterior Talotibial Capsulotomy And Tendon(S) Lengthening (Eg, Resistant Clubfoot Deformity) |
| 28299-CPT | High | Correction Hallux Valgus (Bunionectomy) With Sesamoidectomy When Perfomred; With Double Osteotomy Any Method. (Desc Revised 1/1/2017) |
| 28304-CPT | High | Osteotomy, Midtarsal Bones, Not Calcaneu |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 28304. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 28304 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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