CPT 28465 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 | • 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 28465 |
National average reimbursement for CPT 28465 by major payers:
$863.00
$836.30
$890.89
$1,065.50
| 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 28465 | ||||||
United | 28465 | $3850.00 | 1669586376 - JEFFERSON AMBULATORY SURGERY CENTER LLC | 202349222 - (LA) JEFFERSON AMBULATORY SURGERY C | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28465 | $1326.00 | 1902849227 - EYE SURGERY CENTER, LLC | 371221499 - (IL) EYECARE MANAGEMENT, LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28465 | $1588.00 | 1629032446 - AMBULATORY SURGERY CENTER GROUP LTD | 592073099 - (FL) AMBULATORY SURGERY CENTER GROUP LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28465 | $4480.00 | 1518634732 - MEDSTAR HEALTH ENDOSCOPY CENTER | 872341245 - (MD) MEDSTAR HEALTH ENDOSCOPY CENTER | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28465 | $829.00 | 1700876703 - RIVERSIDE SURGERY CENTER INC | 593599967 - (FL) RIVERSIDE SURGERY CENTER INC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28465 | $6492.00 | 1184714214 - GAINESVILLE ENDOSCOPY CENTER, LLC | 10750801 - (GA) GAINESVILLE ENDOSCOPY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28465 | $6492.00 | 1841251501 - ST AUGUSTINE ENDOSCOPY CENTER LLC | 592947745 - (FL) ST AUGUSTINE ENDOSCOPY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28465 | $5000.00 | 1568950996 - HOLLYWOOD REGIONAL SURGERY CENTER LLC | 825140248 - (FL) HOLLYWOOD REGIONAL SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28465 | $3275.00 | 1033773023 - VISION PARK SURGERY CENTER, LLC | 832719581 - (TX) VISION PARK SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28465 | $512.52 | 1285936377 - LISA ISAACS | 350593390 - DEACONESS HOSPITAL INC | IN | Nurse Practitioner (363L00000X) |
United | 28465 | $2035.00 | 1811512734 - SSL ENDOSCOPY CENTER LLC, AVALA SURGERY CENTER | 843735506 - (LA) SSL ENDOSCOPY CENTER LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28465 | $2036.00 | 1851548655 - CHARLOTTE GASTROENTEROLOGY & HEPATOLOGY, PLLC | 562059693 - (NC) CHARLOTTE GASTROENTEROLOGY & HEPATOLOGY, PLLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28465 | $700.00 | 1881101335 - BROWN MEDICINE, BROWN MEDICINE ENDOSCOPY CENTER | 50450410 - BROWN MEDICINE | RI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28465 | $3373.00 | 1609206614 - HURST AMBULATORY SURGERY CENTER, LLC, PRECINCT AMBULATORY SURGERY CENTER, LLC | 463648821 - (TX) HURST AMBULATORY SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28465 | $4520.00 | 1245239656 - SURGERY CENTER OF GILBERT LLC, SURGERY CENTER OF GILBERT | 731596190 - (AZ) SURGERY CENTER OF GILBERT, LLC | AZ | 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 28465 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 28465 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 28465 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 |
|---|---|---|
| 28450-CPT | Moderate | Treatment Of Closed Tarsal Bone Fracture (Except Talus And Calcaneus); Without Manipulation, Each |
| 28455-CPT | Moderate | Treatment Of Closed Tarsal Bone Fracture (Except Talus And Calcaneus); With Manipulation, Each |
| 28456-CPT | Moderate | Treatment Of Closed Tarsal Bone Fracture (Except Talus And Calcaneus); With Manipulation And Percutaneous Pinning, Eac |
| 28465-CPT | Moderate | Open Treatment Of Closed Or Open Tarsal Bone Fracture (Except Talus And Calcaneus), With Or Without Internal Or Ex |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 28465. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 28465 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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