CPT 28485 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 | • 24 - Ambulatory Surgical Center • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • LT - Left side of body • RT - Right side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 28485 |
National average reimbursement for CPT 28485 by major payers:
$763.90
$723.64
$773.51
$933.31
| 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 28485 | ||||||
United | 28485 | $6588.00 | 1124261771 - KHS AMBULATORY SURGERY CENTER, LLC, SELECT SURGICAL CENTER AT KENNEDY | 260715364 - (NJ) KHS AMBULATORY SURGERY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28485 | $1500.00 | 1598372963 - ALLIANCE SURGERY CENTER AT PEACHTREE CITY LLC | 853147678 - (GA) ALLIANCE SURGERY CENTER AT PEACHTREE CITY LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28485 | $6588.00 | 1194027920 - GRANT SURGICENTER LLC | 331166588 - (PA) GRANT SURGICENTER, LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28485 | $3959.00 | 1093069452 - UROLOGY SPECIALISTS SURGERY CENTER, LLC | 460876134 - (GA) UROLOGY SPECIALISTS SURGERY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28485 | $4367.00 | 1700363611 - APOLLO AMBULATORY SURGERY CENTER, LLC | 830828395 - (MO) APOLLO AMBULATORY SURGERY CENTER LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28485 | $444.26 | 1104877430 - CHARLENE BUCHANAN | 350593390 - DEACONESS HOSPITAL INC | FL | Certified Registered Nurse Anesthetist (367500000X) |
United | 28485 | $1004.00 | 1184697930 - THE ALEXANDRIA OPHTHALMOLOGY ASC LLC, WALLACE LASER AND SURGERY CENTER | 752830937 | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28485 | $966.94 | 1962757286 - MATHURA BABU | 350593390 - DEACONESS HOSPITAL INC | MI | Hospitalist Physician (208M00000X) |
United | 28485 | $822.00 | 1538113238 - ADVANCED LASER & SURGICENTER OF ARIZONA, PC | 721546625 | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28485 | $6146.00 | 1558327213 - SURGICARE OF JACKSON LTD | 752162993 - (MS) SURGICARE OF JACKSON LTD | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28485 | $7415.00 | 1902228455 - PROVIDENCE HEALTH & SERVICES WASHINGTON, PROVIDENCE SURGERY AND PROCEDURE CENTER | 881232814 - (WA) PROVIDENCE SURGERY AND PROCEDURE CENTER LLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28485 | $2446.00 | 1508869645 - FRESNO CA ENDOSCOPY ASC, LP, CENTRAL CALIFORNIA ENDOSCOPY CENTER | 912127626 - (CA) FRESNO CA ENDOSCOPY ASC LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28485 | $2593.00 | 1295086049 - WOMENS CENTER FOR ADVANCED SURGERY INC | 454798001 - (GA) WOMENS CENTER FOR ADVANCED SURGERY INC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28485 | $2500.00 | 1588839609 - RIVERWALK AMBULATORY SURGERY CENTER LLC | 260594903 - (FL) RIVERWALK AMBULATORY SURGERY CENTER, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28485 | $4283.00 | 1255787867 - THE METROHEALTH SYSTEM, METROHEALTH SYSTEM PARMA AMBULATORY SURGERY CENTER | 346004382 | OH | 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 28485 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 28485 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 28485 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 28485. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 28485 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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