CPT 28405 Fee Schedule
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.
| Key Fact | Detail |
|---|---|
| Service Type | Fracture and/or Dislocation Procedures on the Foot and Toes Surgical Procedures on the Foot and Toes |
| Common Place of Service | 21 - Inpatient Hospital 11 - Office |
| Common Modifiers | None RT - Right side of body LT - Left side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 28405 |
National average reimbursement for CPT 28405 by major payers:
$589.38
$526.56
$550.94
$684.74
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 28405 | $1250.00 | 1023359627 - THE EMORY CLINIC INC., EMORY AESTHETIC CENTER | 582030692 - EMORY UNIVERSITY | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28405 | $1108.00 | 1841444593 - TEANECK SURGICAL CENTER, LLC | 10776897 - (NJ) TEANECK SURGICAL CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28405 | $574.00 | 1366559122 - HARVARD PARK SURGERY CENTER, LLC, HARVARD PARK SURGERY CENTER | 331107194 - (CO) HARVARD PARK SURGERY CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28405 | $150.00 | 1720270879 - AKSTEIN EYE CENTER, ASC, AKSTEIN EYE CENTER, ASC | 581597344 - (GA) AKSTEIN EYE CENTER PC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28405 | $163.00 | 1831545904 - MGH SURGERY LLC | 472736896 - (WV) MGH SURGERY LLC | WV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28405 | $108.00 | 1225745870 - APOLLO SURGICAL CENTER LLC | 922033557 - (AZ) APOLLO SURGICAL CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28405 | $72.00 | 1538154604 - PAIN MANAGEMENT & SURGERY CENTER OF SOUTHERN INDIANA | 351972676 | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28405 | $1136.00 | 1962435990 - NORTHERN MONMOUTH REGIONAL SURGERY CENTER LLC, CENTER FOR BONE AND JOINT SURGERY | 201026094 - (NJ) NORTHERN MONMOUTH REGIONAL SURGERY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28405 | $175.00 | 1285083477 - GEORGIA INTERVENTIONAL PAIN | 810948119 - (GA) GEORGIA INTERVENTIONAL PAIN | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28405 | $147.00 | 1417935206 - DIGESTIVE DISEASE CENTER, LP, MEMORIAL CARE DIGESTIVE CARE CENTER SADDLEBACK MEMORIAL, AN AFFILIATE | 330292435 - (CA) DIGESTIVE DISEASE CENTER LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28405 | $318.00 | 1487604500 - CYPRESSWOOD SURGERY CENTER LLC, LEGENT SURGERY CENTER CYPRESSWOOD | 680600120 - (TX) CYPRESSWOOD SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28405 | $476.00 | 1124125331 - AMBULATORY SURGERY ASSOCIATES, LLC, BROOKSIDE SURGERY CENTER | 383237596 - (MI) AMBULATORY SURGERY ASSOCIATES | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28405 | $1180.00 | 1225064876 - ROCK HILL SURGERY CENTER, LLC, CAROLINA SURGICAL CENTER | 752562111 - (SC) ROCK HILL SURGERY CENTER LLC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28405 | $531.00 | 1649223124 - CAMP LOWELL SURGERY CENTER,LLC, CAMP LOWELL SURGERY CENTER | 201086556 - (AZ) CAMP LOWELL SURGERY CENTER | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28405 | $115.00 | 1073571766 - BOCA RATON OUTPATIENT SURGERY & LASER CENTER LTD | 650241934 - (FL) BOCA RATON OUTPATIENT SURGERY LASER CENTER LTD | FL | 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 28405 vs. Other Surgical Procedures on the Foot and Toes Codes
The CPT 28405 code is part of the Fracture and/or Dislocation Procedures on the Foot and Toes services used for Surgical Procedures on the Foot and Toes. 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 28405 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 |
|---|---|---|
| 28400-CPT | Moderate | Closed Treatment Of Calcaneal, Closed Treatment Of Calcaneal Fracture Without Manipulationclosed Treatment Of Calcaneal Fracture Without Manipulation |
| 28405-CPT | Moderate | Closed Treatment Of Calcaneal, Closed Treatment Of Calcaneal Fracture With Manipulationclosed Treatment Of Calcaneal Fracture With Manipulation |
| 28406-CPT | Moderate | Percutaneous Skeletal Fixation, Percutaneous Skeletal Fixation Of Calcaneal Fracture Withmanipulation Percutaneous Skeletal Fixation Of Calcaneal Fracture With |
| 28415-CPT | High | Surgery To Repair Broken Heel, Surgery To Repair A Broken Heel Bone (Calcaneus). Pins Wires Screws Or Plates May Be Used To Hold The Bone Together. A Bone Graft From Another Part Of The Body May Be Used. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 28405. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 28405 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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