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See a sample rate comparisonCPT 28315 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Sesamoidectomy 1st Toe
| 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 | Moderate |
| Medicare Fee Schedule | View Medicare rates for 28315 |
| Medicaid Fee Schedule | View Medicaid rates for 28315 |
National average reimbursement for CPT 28315 by major payers:
$601.06
$630.82
$649.32
$552.00
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CPT 28315
5 of 25 sample ratesHigher to lower in this preview
Greenville Surgery Center, LLC, Texas Health Surgery Center Dallas
Greenville Surgery Center LLC
$4,141.00Published rateEye Surgery Center Of Lenoir City, LLC
Eye Surgery Center Of Lenoir City LLC
$1,134.00Published rateAesthetic Surgery Center Of Eugene Inc
$827.00Published rateWest Central Surgical Center, LLC
West Central Surgical Center LLC
$605.00Published rateAlysen Weinzapfel
Deaconess Hospital Inc
$396.95Published rate
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See a sample payer proposalCPT 28315 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 28315 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 28315 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 |
|---|---|---|
| 28175-CPT | Moderate | Remove Growth From Foot Bone, Surgery To Remove An Abnormal Growth (Tumor) From A Bone In The Foot. |
| 28232-CPT | Moderate | Tenotomy Open Tndon Flexor; Toe Sngle Tndon (Sepa Proc), Tenotomy Open Tendon Flexor; Toe Single Tendon (Separate Procedure) |
| 28234-CPT | Moderate | Tenotomy Open Extensor Foot/Toe |
| 28315-CPT | Moderate | Sesamoidectomy 1st Toe |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 28315. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 28315 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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