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See a sample rate comparisonCPT 28420 Fee Schedule
Last Verified: October 2026
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.
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.
| 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 LT - Left side of body RT - Right side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 28420 |
| Medicaid Fee Schedule | View Medicaid rates for 28420 |
National average reimbursement for CPT 28420 by major payers:
$1,770.45
$1,707.40
$1,759.15
$2,093.00
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CPT 28420
5 of 25 sample ratesHigher to lower in this preview
Aurora Surgery Centers, LLC, Aurora Pleasant Prairie Ambulatory Surgery Center
Aurora Surgery Centers LLC
$14,053.00Published rateFirst Hill Surgery Center LLC
$5,516.00Published rateDoctors Hospital, Inc, Baptist Health Surgery Center Coral Gables
Doctors Hospital Inc
$4,072.00Published rateSt. Mary'S Surgical Center LLC, St. Mary'S Surgical Center
St Marys Surgical Center LLC
$2,481.00Published rateBergen Gastroenterology PC
Bergen Gastroenterology, P.C.
$840.00Published rate
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See a sample payer proposalCPT 28420 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 28420 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 28420 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 |
| 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. |
| 28420-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 28420. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 28420 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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