CPT 28470 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 | • 11 - Office • 23 - Emergency Room |
| Common Modifiers | • None • LT - Left side of body • RT - Right side of body |
| Complexity Level | Moderate |
National average reimbursement for CPT 28470 by major payers:
$267.61
$289.23
$309.22
$372.45
| 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 28470 | ||||||
United | 28470 | $365.00 | 1235255605 - EAGLE EYE SURGERY AND LASER CENTER LLC, EAGLE EYE SURGERY & LASER CENTER | 820521864 - (ID) EAGLE EYE SURGERY AND LASER CENTER LLC | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28470 | $891.00 | 1053303826 - NEW ENGLAND LASER AND COSMETIC SURGERY CENTER LLC | 510480367 | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28470 | $172.50 | 1700967106 - EBSC, LLC, SURGICAL CARE CENTER OF MICHIGAN | 382840421 - (MI) EBSC LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28470 | $1413.00 | 1821242488 - SPECIALTY SURGICAL CENTER OF NORTH BRUNSWICK, LLC | 208770654 - (NJ) SPECIALTY SURGICAL CENTER OF N | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28470 | $176.63 | 1619120300 - TUSHAR NAYAR | 350593390 - DEACONESS HOSPITAL INC | KY | Internal Medicine Physician (207R00000X) |
United | 28470 | $285.00 | 1508135658 - SURGERY CENTER OF ATHENS LLC | 450581955 - (GA) SURGERY CENTER OF ATHENS LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28470 | $166.00 | 1558672626 - CALIFORNIA COLON AND RECTAL CANCER SCREENING CENTER LLC, CALIFORNIA COLON ANDD RECTAL CANCER SCREENING CENTER LLC | 273443611 - (CA) CALIFORNIA COLON AND RECTAL CANCER SCREENING CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28470 | $600.00 | 1740491422 - PV PENINSULA PLASTIC SURGERY CENTER | 208545497 - (CA) PV PENINSULA PLASTIC SURGERY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28470 | $600.00 | 1861504037 - BOULEVARD SURGICENTER, INC. | 203112450 - (CA) BOULEVARD SURGICENTER INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28470 | $96.00 | 1003858721 - PIEDMONT ENDOSCOPY CENTER, INC. | 561634105 | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28470 | $148.00 | 1326048091 - LOURDES AMBULATORY SURGERY CENTER LLC | 205588350 | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28470 | $107.00 | 1093842270 - NORTH GEORGIA EYE SURGERY CENTER LLC | 201510754 - (GA) NORTH GEORGIA EYE SURGERY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28470 | $500.00 | 1750616249 - IDAHO ENDOSCOPY CENTER LLC | 270996353 - (ID) IDAHO ENDOSCOPY CENTER LLC | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28470 | $171.00 | 1194437624 - WATAUGA SURGICAL PARTNERS PLLC | 862624496 - (TN) WATAUGA SURGICAL PARTNERS PLLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28470 | $600.00 | 1740289024 - KOOTENAI OUTPATIENT SURGERY CNTR LLC, KOOTENAI OUTPATIENT SURGERY | 820523354 - (ID) KOOTENAI OUTPATIENT SURGERY | ID | 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 28470 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 28470 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 28470 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 |
|---|---|---|
| 28470-CPT | Moderate | Closed Treatment Of Broken Foot Bone In The Fore Or Midfoot Without Manipulation |
| 28475-CPT | Moderate | Treatment Of Closed Metatarsal Fracture; With Manipulation, Each |
| 28476-CPT | Moderate | Treatment Of Closed Metatarsal Fracture; With Manipulation And Percutaneous Pinning, Each |
| 28485-CPT | Moderate | Open Treatment Of Closed Or Open Metatarsal Fracture, With Or Without Internal Or External Skeletal Fixation, Ea |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 28470. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 28470 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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