CPT 28490 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 | • 23 - Emergency Room • 11 - Office |
| Common Modifiers | • None • 54 - Surgical Care Only • T5 - Right foot, great toe |
| Complexity Level | Low |
National average reimbursement for CPT 28490 by major payers:
$186.20
$187.05
$199.66
$241.91
| 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 28490 | ||||||
United | 28490 | $125.00 | 1376501064 - SOUTH CENTRAL SURGICAL CENTER, LLC, CENTER FOR SPECIALTY CARE | 411952256 - (MN) SOUTH CENTRAL SURGICAL CENTER LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28490 | $207.00 | 1932718822 - CHARLES REGIONAL SURGICAL CENTER LLC | 833560882 - (MD) CHARLES REGIONAL SURGICAL CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28490 | $1299.00 | 1275596314 - JOHNSON COUNTY SURGERY CENTER, L.P. | 342029776 - (KS) JOHNSON COUNTY SURGERY CENTER LP | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28490 | $120.00 | 1144845116 - LEGACY CENTER FOR SPINAL SURGERY, LLC | 843166515 - (GA) LEGACY CENTER FOR SPINAL SURGERY LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28490 | $100.00 | 1457350449 - BAPTIST AND PHYSICIANS OUTPATIENT SURGERY CENTER OF NORTH MS, LP, OXFORD SURGERY CENTER | 640925692 - (MS) BAPTIST AND PHYSICIANS OUTPATIENT SURGERY CENTER OF NORTH MS LP | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28490 | $228.00 | 1164852455 - NURA SURGICAL CENTER LLC, MINNEAPOLIS PAIN CENTERS LLC | 901026241 | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28490 | $531.00 | 1093772840 - THE SURGERY CENTER AT JENSEN BEACH, LLC | 651198731 - (FL) THE SURGERY CENTER AT JENSEN B | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28490 | $186.00 | 1518311141 - THE REGENTS OF THE UNIVERSITY OF CALIFORNIA, UCLA DEPT OF MEDICINE | 954373071 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28490 | $206.00 | 1407801509 - ATLANTIC SURGERY CENTER,LLC | 223625894 - (NJ) ATLANTIC SURGERY CENTERLLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28490 | $531.00 | 1245711803 - SURGCENTER CLEARWATER, LLC, SURGCENTER DUNEDIN | 823682684 - (FL) SURGCENTER CLEARWATER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28490 | $253.36 | 1821155532 - LARRY CRICK | 350593390 - DEACONESS HOSPITAL INC | KY | Pediatrics Physician (208000000X) |
United | 28490 | $566.00 | 1720085277 - ROSWELL SURGERY CENTER LLC, ROSWELL SURGERY CENTER | 582577112 - (GA) ROSWELL SURGERY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28490 | $137.00 | 1649925801 - MUSIC CITY SURGERY CENTER, LLC | 872654999 - (TN) MUSIC CITY SURGERY CENTER LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28490 | $963.00 | 1366137440 - SURGERY CENTER OF GEORGETOWN, LLC, GEORGETOWN SURGERY CENTER | 880604963 - (TX) SURGERY CENTER OF GEORGETOWN LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28490 | $232.00 | 1447293113 - WESTERN AMBULATORY SURGERY LLC | 830303151 - (WY) WESTERN AMBULATORY SURGERY LLC | WY | 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 28490 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 28490 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 28490 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 |
|---|---|---|
| 28490-CPT | Low | Treatment Of Closed Fracture Great Toe, Phalanx Or Phalanges; Without Manipulation |
| 28495-CPT | Moderate | Treatment Of Closed Fracture Great Toe, Phalanx Or Phalanges; With Manipulation |
| 28496-CPT | Moderate | Treatment Of Closed Fracture Great Toe, Phalanx Or Phalanges; With Manipulation And Percutaneous Pinning |
| 28505-CPT | Moderate | Open Treatment Of Closed Or Open Fracture Great Toe, Phalanx Or Phalanges, With Or Without Internal Or External Skele |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 28490. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 28490 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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