CPT 28309 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 28309 by major payers:
$1,169.93
$1,202.56
$1,225.62
$1,508.24
| 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 28309 | ||||||
United | 28309 | $6010.00 | 1831109560 - NEW MEXICO ORTHOPAEDIC SURGERY CENTER, LLC, NEW MEXICO SURGERY CENTER ORTHOPAEDICS | 621797896 | NM | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28309 | $4250.00 | 1255875126 - VIP SURG ASC, LLC, VIP SURGICAL CENTER | 811621842 - (TX) VIP SURG ASC LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28309 | $1500.00 | 1407095359 - PAIN CARE CENTER OF GEORGIA LLC | 300523580 - (GA) PAIN CARE CENTER OF GEORGIA LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28309 | $6588.00 | 1760486369 - MOUNTAIN EMPIRE SURGERY CENTER LP | 621772667 - (TN) MOUNTAIN EMPIRE SURGERY CENTER LP | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28309 | $6588.00 | 1053764779 - SURGCENTER OF ST. LUCIE, LLC | 475425011 - (FL) SURGCENTER OF ST. LUCIE, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28309 | $722.10 | 1619120300 - TUSHAR NAYAR | 350593390 - DEACONESS HOSPITAL INC | KY | Internal Medicine Physician (207R00000X) |
United | 28309 | $5484.00 | 1972541415 - OCEAN ENDOSURGERY CENTER LLC, OCEAN ENDOSURGERY CENTER | 223564617 - (NJ) OCEAN ENDOSURGERY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28309 | $5098.00 | 1952540825 - ROME ORTHOPAEDIC CLINIC ASC, INC. | 261595646 - (GA) ROME ORTHOPAEDIC CLINIC ASC INC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28309 | $1571.65 | 1710479761 - MOLLIE WETSTEIN | 350593390 - DEACONESS HOSPITAL INC | IN | Family Medicine Physician (207Q00000X) |
United | 28309 | $1571.65 | 1154384261 - UMESH JAIRATH | 350593390 - DEACONESS HOSPITAL INC | IN | Interventional Cardiology Physician (207RI0011X) |
United | 28309 | $1571.65 | 1417246877 - SHIV BHANDARI | 350593390 - DEACONESS HOSPITAL INC | AZ | Internal Medicine Physician (207R00000X) |
United | 28309 | $1766.00 | 1417987595 - ENDOSCOPY CENTER OF NORTH BALTIMORE | 412081861 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28309 | $1155.00 | 1427092279 - IPM SURGERY CENTERS LLC, SPINALCARE SURGICENTER | 330983021 - (CA) IPM SURGERY CENTERS, INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28309 | $2266.00 | 1407829773 - LA JOLLA ENDOSCOPY CENTER LP, LA JOLLA ENDOSCOPY CENTER | 621806062 - (CA) LA JOLLA ENDOSCOPY CENTER LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28309 | $1541.00 | 1982074001 - CLINICAL ASSOCIATES P A, CLINICAL ASSOCIATES, ASC | 465765243 - (MD) CLINICAL ASSOCIATES, P.A. | MD | 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 28309 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 28309 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 28309 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 |
|---|---|---|
| 28289-CPT | Moderate | Hallux Rigidus Correction With Cheilectomy Debridement And Capsular Release Of The First Metatarsophalangeal Joint; Without Implant. (Desc Revised 1/1/2017) |
| 28292-CPT | Moderate | Correction Hallux Valgus (Bunionectomy) With Sesamoidectomy When Performed; With Resection Of Proximal Phalanx Base When Performed Any Method.(Desc Revised 1/1/2017) |
| 28300-CPT | Moderate | Osteotomy;Calcaneus-Dwyer/Chambers Type- |
| 28309-CPT | High | Osteotomy, With Or Without Lengthening, Shortening Or Angular Correction, Metatarsal; Multiple (Eg, Swanson Type Cavus Foot Procedure) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 28309. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 28309 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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