CPT 28495 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 • TA - Left foot, great toe |
| Complexity Level | Moderate |
National average reimbursement for CPT 28495 by major payers:
$236.77
$232.64
$243.52
$302.45
| 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 28495 | ||||||
United | 28495 | $102.00 | 1104857523 - SURGERY CENTER OF ST. JOSEPH, LLC | 371439847 - (MO) SURGERY CENTER OF ST JOSEPH LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28495 | $52.00 | 1932321882 - DIGESTIVE HEALTH CENTER OF HUNTINGTON | 811030907 - (NY) DHCH, LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28495 | $175.00 | 1093389421 - PEACHTREE ORTHOPAEDIC SURGERY CENTER-NORTH, LLC | 862640910 - (GA) PEACHTREE ORTHOPAEDIC SURGERY CENTERNORTH LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28495 | $60.00 | 1962455428 - VALLEY EYE INSTITUTE ASC LLC, CVP SURGERY CENTER | 200080762 - (OH) VALLEY EYE INSTITUTE ASC LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28495 | $454.00 | 1952405284 - CHILDRENS HEALTH CARE SERVICES INC, CHILDRENS MINNETONKA | 411756478 - (MN) CHILDRENS HEALTH CARE SERVICES INC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28495 | $643.00 | 1023071560 - MEDICAL PLAZA AMBULATORY SURGERY CENTER ASSOCIATES, L.P., MEDICAL CITY SURGERY CENTER/FORT WORTH | 621489404 - (TX) MEDICAL PLAZA AMBULATORY SURGERY CENTER ASSOCIATES LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28495 | $4613.00 | 1477846145 - INDIANA UNIVERSITY HEALTH SAXONY SURGERY CENTER LLC, SAXONY SURGERY CENTER | 352072586 | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28495 | $265.00 | 1457087926 - SPOKANE UROLOGY, PLLC, UROLOGY SURGERY CENTER NORTHWEST | 911043589 - (WA) SPOKANE UROLOGY, INC., P.S. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28495 | $300.00 | 1164527933 - NORTHWEST AMBULATORY SURGERY SERVICES, LLC, BELLINGHAM AMBULATORY SURGERY CENTER | 911830115 - (WA) NORTHWEST AMBULATORY SURGERY SERVICES, LLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28495 | $531.00 | 1790104248 - METRO SURGERY CENTER, LLC, METRO SURGERY CENTER, LP | 810587498 - (AZ) METRO SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28495 | $94.00 | 1841270675 - EYECARE CONSULTANTS SURGERY CENTER, LLC, EYECARE CONSULTANTS SURGERY CENTER | 621619550 - (IN) EYECARE CONSULTANTS SURGERY CENTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28495 | $79.00 | 1154555472 - GEORGIA RETINA SURGERY CENTER, LLC | 262303683 - (GA) GEORGIA RETINA SURGERY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28495 | $286.00 | 1942261599 - SDOSC, LP, SAN DIEGO OUTPATIENT AMBULATORY SURGICAL CENTER | 30506487 - (CA) SDOSC, LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28495 | $260.00 | 1588679179 - SPECIALTY SURGICAL CENTER OF ENCINO LP | 954816334 - (CA) SPECIALTY SURGICAL CENTER OF ENCINO, LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28495 | $574.00 | 1144331760 - RESURGENS SURGERY CENTER LLC | 582397841 - (GA) RESURGENS SURGERY CENTER LLC | GA | 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 28495 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 28495 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 28495 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 |
|---|---|---|
| 28341-CPT | Moderate | Repair Toe Macrodactyly Bone Resect |
| 28345-CPT | Moderate | Repair Toe Syndactyly |
| 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 |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 28495. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 28495 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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