CPT 28476 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 |
| Common Modifiers | • None • RT - Right side of body • LT - Left side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 28476 |
National average reimbursement for CPT 28476 by major payers:
$511.91
$481.03
$517.59
$635.91
| 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 28476 | ||||||
United | 28476 | $2206.00 | 1306843222 - ST. JOSEPH'S OUTPATIENT SURGERY CENTER, LLC | 562332449 - (AZ) ST JOSEPHS OUTPATIENT SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28476 | $1178.00 | 1750331435 - EYE HEALTH ASSOCIATES INC | 161583927 - (NY) EYE HEALTH ASSOCIATES INCORPORAT | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28476 | $8705.00 | 1598270076 - BELTWAY SURGERY CENTERS, LLC, SAXONY SURGERY CENTER | 352072586 | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28476 | $618.72 | 1386748903 - REZA MOHAMMADI | 350593390 - DEACONESS HOSPITAL INC | IN | Emergency Medicine Physician (207P00000X) |
United | 28476 | $936.00 | 1497296198 - MIDATLANTIC ENDOSCOPY LLC, MID-ATLANTIC GASTROINTESTINAL CENTER II | 814079161 | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28476 | $2859.00 | 1366416125 - TEXAS ORTHOPEDICS SURGERY CENTER, LLC, TEXAS ORTHOPEDICS SURGERY CENTER LIMITED PARTNERSHIP, LL | 743013713 - (TX) TEXAS ORTHOPEDICS SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28476 | $1345.00 | 1689175333 - NEPHROLOGY & ENDOCRINE ASSOCIATES INC | 880136773 - (NV) NEPHROLOGY & ENDOCRINE ASSOCIATES INC | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28476 | $710.00 | 1760423180 - CENTRAL COAST ENDOSCOPY CENTER INC | 770456846 - (CA) CENTRAL COAST ENDOSCOPY CENTER INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28476 | $1232.00 | 1083780662 - PLASTIC SURGICENTRE, INC, THE PLASTIC SURGICENTRE, INC | 911473281 - (WA) THE PLASTIC SURGICENTRE, INC. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28476 | $5594.00 | 1770252868 - STONESPRINGS SURGICENTER, LLC | 812929320 - (VA) STONESPRINGS SURGICENTER LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28476 | $756.00 | 1841589116 - RENAISSANCE SURGERY CENTER OF CHATTANOOGA, LLC | 273013392 - (TN) RENAISSANCE SURGERY CENTER OF CHATTANOOGA LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28476 | $1048.00 | 1487655627 - UNION PINES SURGERY CENTER,LLC | 731622427 - (OK) UNION PINES SURGERY CENTER, LLC | OK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28476 | $1246.00 | 1770147217 - ANDOVER AMBULATORY SURGERY CENTER, LLC | 830649332 - (KS) ANDOVER AMBULATORY SURGERY CENTER LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28476 | $1479.00 | 1497834931 - VISION CARE CENTER, A MEDICAL GROUP INC, EYE-Q SURGERY CENTER | 941717441 - VISION CARE CENTER, A MEDICAL GROUP, INC. | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28476 | $1919.00 | 1740231489 - STONEGATE SURGERY CENTER LP | 201211544 - (TX) STONEGATE SURGERY CENTER LP | TX | 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 28476 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 28476 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 28476 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 28476. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 28476 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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