CPT 28436 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 • 22 - On Campus Outpatient Hospital • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • RT - Right side of body • LT - Left side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 28436 |
National average reimbursement for CPT 28436 by major payers:
$649.86
$613.43
$641.51
$810.71
| 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 28436 | ||||||
United | 28436 | $3553.00 | 1902877715 - AMBULATORY SURGICAL CENTER OF MORRIS COUNTY LLC, RIDGEDALE SURGERY CENTER | 223104481 - (NJ) AMBULATORY SURGICAL CENTER OF MORRIS COUNTY, INC. | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28436 | $2353.00 | 1730713439 - FLORIDA SPRINGS SURGERY CENTER LLC | 832895293 - (FL) FLORIDA SPRINGS SURGERY CENTER L | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28436 | $1700.00 | 1720495708 - TRI-CITY ORTHOPAEDIC CLINIC P S C, THE SURGERY CENTER AT TCO (KENNEWICK) | 911866685 - (WA) TRI-CITY ORTHOPAEDIC CLINIC, PSC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28436 | $1169.00 | 1194091801 - UNITY LINDEN OAKS SURGERY CENTER, LLC | 800798208 | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28436 | $1300.00 | 1306435086 - PHOENIX SPINE AND JOINT GILBERT ASC, LLC | 853605981 | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28436 | $2353.00 | 1255577045 - MAPLE LAWN SURGERY CENTER | 262739529 - (MD) MAPLE LAWN SURGERY CENTER, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28436 | $1006.00 | 1053319053 - EYE SURGERY CENTER OF NEW ALBANY, LLC, NOVAMED EYE SURGERY CENTER OF NEW ALBANY, LLC | 364148241 - (IN) EYE SURGERY CENTER OF NEW ALBANY LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28436 | $998.00 | 1336366442 - CASTLE HILLS OUTPATIENT CENTER, INC., SURGICAL ARTS CENTER | 742931255 - (TX) CASTLE HILLS OUTPATIENT CENTER INC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28436 | $1861.00 | 1114696234 - ONE NINETEEN GI ASC, LLC | 862162590 - (AL) ONE NINETEEN GI ASC LLC | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28436 | $1690.00 | 1902078207 - PLAINFIELD SURGERY CENTER, LLC | 300391104 - (IL) PLAINFIELD SURGERY CENTER LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28436 | $1200.00 | 1427307578 - HEMLOCK AMBULATORY SURGERY CENTER | 455511791 - (GA) HEMLOCK AMBULATORY SURGERY CENTER | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28436 | $1552.00 | 1932164852 - MAY STREET SURGI CENTER, LLC, MAY STREET SURGI CENTER | 223777533 - (NJ) MAY STREET SURGI CENTER, LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28436 | $1490.00 | 1083643852 - AMARILLO COLONOSCOPY CENTER LP, PANHANDLE ENDOSCOPY CENTER LP | 202528490 - (TX) AMARILLO COLONOSCOPY CENTER, LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28436 | $3500.00 | 1780683490 - METROCREST SURGERY CENTER LP, BAYLOR SURGICARE AT CARROLLTON | 30380493 - (TX) METROCREST SURGERY CENTER LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28436 | $1225.00 | 1477559839 - SURGERY CENTER OF NORTHERN COLORADO, EYE CENTER OF NORTHEN COLORADO SURGERY CENTER | 841420378 - (CO) SURGERY CENTER OF NORTHERN COLORADO | CO | 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 28436 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 28436 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 28436 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 28436. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 28436 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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