CPT 28435 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 | • Surgery • Surgical Procedures on the Musculoskeletal System |
| 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 28435 |
National average reimbursement for CPT 28435 by major payers:
$494.41
$460.83
$488.65
$605.42
| 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 28435 | ||||||
United | 28435 | $1007.00 | 1518995513 - AFFILIATED ENDOSCOPY CENTERS, LLC | 411923237 - (MN) AFFILIATED ENDOSCOPY CENTERS LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28435 | $1233.00 | 1881013142 - ADVANCED SURGERY CENTER OF TAMPA, LLC | 463891843 - (FL) ADVANCED SURGERY CENTER OF TAMPA, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28435 | $670.00 | 1609896539 - CEDAR HILLS AMBULATORY SURGERY CENTER LLC, CEDAR HILLS SURGERY CENTER | 680580628 - (OR) CEDAR HILLS AMBULATORY SURGERY CENTER LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28435 | $2307.00 | 1306163431 - ROC SURGERY LLC, RILEY OUTPATIENT SURGERY CENTER | 271497960 - (IN) ROC SURGERY LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28435 | $906.00 | 1659574283 - PROVIDENCE VENTURES, LLC, BONE AND JOINT SURGERY CENTER OF NOVI | 161704029 - (MI) PROVIDENCE VENTURES, LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28435 | $448.17 | 1205859550 - COMMUNITY SURGERY & LASER CENTER, LLC | 204589384 - (PA) COMMUNITY SURGERY LASER CENTER LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28435 | $1258.00 | 1194724690 - ENDOSCOPY CENTER OF DAYTON NORTH LLC | 311703317 - (OH) ENDOSCOPY CENTER OF DAYTON NORTH LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28435 | $900.00 | 1821459496 - GEM STATE ENDOSCOPY | 352553021 - (ID) GEM STATE ENDOSCOPY | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28435 | $898.00 | 1184664609 - ENDOSCOPY CENTER AT ROBINWOOD, LLC | 20615867 - (MD) ENDOSCOPY CENTER AT ROBINWOOD LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28435 | $515.00 | 1962743310 - WF ENDOSCOPY CENTER LLC | 611578919 | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28435 | $850.00 | 1063838357 - METROEAST ENDOSCOPIC SURGERY CENTER | 461844105 - (IL) METROEAST ENDOSCOPIC SURGERY CENTER | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28435 | $580.00 | 1053301473 - BAKER AMBULATORY SURGERY CENTER | 710839283 - (AR) BAKER AMBULATORY SURGERY CENTER | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28435 | $970.00 | 1760947717 - ADVANCED ORTHOPAEDIC SURGERY CENTER, LLC, LAS VEGAS INSTITUTE FOR ADVANCED SURGERY | 832874360 - (NV) ADVANCED ORTHOPAEDIC SURGERY CENTER LLC | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28435 | $1167.00 | 1619979580 - PORT ORANGE ENDOSCOPY & SURGERY CENTER LLC, ADVENTHEALTH SURGERY CENTER PORT ORANGE | 201388947 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28435 | $790.00 | 1114922192 - GASTROENTEROLOGY ASSOCIATES ENDOSCOPY CENTER, LLC | 680380691 - (CA) GASTROENTEROLOGY ASSOC. ENDOSCOPY CENTER, LLC. DBA REDDING ENDOSCOPY | CA | 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 28435 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 28435 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 28435 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 |
|---|---|---|
| 28430-CPT | Moderate | Closed Treatment Of Talus Fracture; Without Manipulation |
| 28435-CPT | Moderate | Closed Treatment Of Broken Ankle Joint Bone With Manipulation |
| 28436-CPT | Moderate | Insertion Of Hardware To Broken Ankle Joint With Manipulation, Accessed Through The Skin |
| 28445-CPT | High | Open Treatment Of Closed Or Open Talus Fracture, With Or Without Internal Skeletal Fixation |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 28435. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 28435 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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