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 |
| Medicare Fee Schedule | View Medicare rates for 28490 |
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 | $137.00 | 1649925801 - MUSIC CITY SURGERY CENTER, LLC | 872654999 - (TN) MUSIC CITY SURGERY CENTER LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28490 | $85.00 | 1548235963 - THE SCRANTON PA ENDOSCOPY ASC LP, THE SCRANTON ENDOSCOPY CENTER | 202853361 - (PA) THE SCRANTON PA ENDOSCOPY ASC LP | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28490 | $200.00 | 1164480992 - VICTORIA SURGERY CENTER | 742803100 - (TX) VICTORIA SURGERY CENTER | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28490 | $224.00 | 1962676304 - 32ND STREET SURGERY CENTER, LLC | 261339811 - (MO) 32ND STREET SURGERY CENTER, L.L.C. | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28490 | $574.00 | 1932636123 - TUCSON DIGESTIVE INSTITUTE LLC, ARIZONA DIGESTIVE INSTITUTE | 821568426 | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28490 | $350.00 | 1558313544 - MINNESOTA VALLEY SURGERY CENTER LLC | 203371241 - (MN) MINNESOTA VALLEY SURGERY CENTER LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28490 | $166.00 | 1538647474 - PALOS HEALTH SURGERY CENTER, LLC | 352634975 - (IL) PALOS HEALTH SURGERY CENTER LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28490 | $469.00 | 1720268279 - PEARL ROAD SURGERY CENTER, LLC | 260812886 - (OH) PEARL ROAD SURGERY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28490 | $100.00 | 1396899191 - ALTERNACARE | 311487187 - ALTERNACARE | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28490 | $253.36 | 1821155532 - LARRY CRICK | 350593390 - DEACONESS HOSPITAL INC | KY | Pediatrics Physician (208000000X) |
United | 28490 | $85.00 | 1730442559 - RETINA INSTITUTE OF INDIANA SURGERY CENTER, LLC | 272247549 - (IN) RETINA INSTITUTE OF INDIANA SURGERY CENTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28490 | $1081.00 | 1871838003 - NORTHWEST REGIONAL SURGERY CENTER, LLC | 460823847 - (IN) NORTHWEST REGIONAL SURGERY CENTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28490 | $85.00 | 1730442559 - RETINA INSTITUTE OF INDIANA SURGERY CENTER, LLC | 272247549 - (IN) RETINA INSTITUTE OF INDIANA SURGERY CENTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28490 | $252.00 | 1689682247 - ST. PETERSBURG ENDOSCOPY CENTER LLC | 203046109 - (FL) ST. PETERSBURG ENDOSCOPY CENTER, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28490 | $84.00 | 1336170596 - THE UROLOGIC SURGICAL CENTER LLC | 562354405 - (PA) THE UROLOGIC SURGICAL CENTER LLC | PA | 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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