CPT 28475 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 • RT - Right side of body • LT - Left side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 28475 |
National average reimbursement for CPT 28475 by major payers:
$344.76
$345.99
$349.58
$442.95
| 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 28475 | ||||||
United | 28475 | $1623.00 | 1447355243 - SURGICENTER OF GREATER MILWAUKEE, LLC, SURGICENTER OF GREATER MILWAUKEE, INC. | 391682308 - (WI) CHILDREN'S HOSPITAL AND HEALTH SYSTEM, INC. | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28475 | $1665.00 | 1902052350 - SURGERY CENTER, LLC | 263169180 - (WI) THE SURGERY CENTER, LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28475 | $1250.00 | 1306472063 - THE EMORY CLINIC INC, EMORY ENDOSCOPY CENTER AT DECATUR | 464115055 - (GA) EMORY AMBULATORY SURGERY CENTER AT DUNWOODY LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28475 | $1394.00 | 1568884104 - EMORY AMBULATORY SURGERY CENTER AT DUNWOODY, LLC | 464115055 - (GA) EMORY AMBULATORY SURGERY CENTER AT DUNWOODY LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28475 | $175.00 | 1093389421 - PEACHTREE ORTHOPAEDIC SURGERY CENTER-NORTH, LLC | 862640910 - (GA) PEACHTREE ORTHOPAEDIC SURGERY CENTERNORTH LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28475 | $317.00 | 1588665269 - RF EYE PC, COCHISE EYE & LASER ASC | 860879991 - (AZ) R.F. EYE, PC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28475 | $400.00 | 1366761397 - MEDINA-SUMMIT AMBULATORY SURGERY CENTER, THE MEDINA SURGERY CENTER | 261421110 - (OH) SUMMA HEALTH, PENSION ADMINISTATION COMMITTEE | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28475 | $1150.00 | 1376054007 - HUDSON YARDS SURGERY CENTER, LLC, HUDSON SPECIALTY SURGERY CENTER | 463753455 - (NY) HUDSON YARDS SURGERY CENTER LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28475 | $77.00 | 1194790808 - DIGESTIVE ENDOSCOPY CENTER LLC | 311508446 - (OH) DIGESTIVE ENDOSCOPY CENTER, LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28475 | $186.00 | 1760533830 - GASTROINTESTINAL MEDICAL CENTER ASC | 954373071 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28475 | $531.00 | 1316508252 - MINIMALLY INVASIVE SURGICENTER LLC | 842130499 - (FL) MINIMALLY INVASIVE SURGICENTER L | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28475 | $203.00 | 1508318411 - INTERVENTIONAL SPINE CENTER, LLC | 263161503 - (CA) INTERVENTIONAL SPINE CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28475 | $380.00 | 1174502272 - ENDOSCOPY CENTER OF TOPEKA LP, THE ENDOSCOPY AND SURGERY CENTER OF TOPEKA | 621512368 - (KS) THE ENDOSCOPY CENTER OF TOPEKA L | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28475 | $500.00 | 1376716316 - CPM SURGERY CENTER LLC | 261382311 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28475 | $91.00 | 1194712109 - EXECUTIVE ENDOSCOPY, INC, ENDOSCOPY CENTER OF SAN JOSE | 770583401 - (CA) EXECUTIVE ENDOSCOPY INC | 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 28475 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 28475 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 28475 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 28475. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 28475 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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