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See a sample rate comparisonCPT 28495 Fee Schedule
Last Verified: September 2026
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.
Closed Treatment Of Fracture G, Closed Treatment Of Fracture Great Toe Phalanx Orphalanges With Manipulation Closed Treatment Of Fracture Great Toe Phalanx Or
| 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 |
| Medicare Fee Schedule | View Medicare rates for 28495 |
| Medicaid Fee Schedule | View Medicaid rates for 28495 |
National average reimbursement for CPT 28495 by major payers:
$236.77
$232.64
$243.52
$290.99
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CPT 28495
5 of 25 sample ratesHigher to lower in this preview
Indiana University Health Saxony Surgery Center LLC, Saxony Surgery Center
$4,613.00Published rateBon Secours Surgery Center At Virginia Beach LLC, Bon Secours Surgery Center At Virginia Beach
Bon Secours Surgery Center At Virginia Beach LLC
$586.00Published rateNorth Bend Medical Center Inc, Nbmc-Day Surgery
$250.00Published rateCorridor Surgery Center
$120.00Published rateNortheast Ambulatory Center Inc
Northeast Ambulatory Center, Inc.
$50.00Published rate
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See a sample payer proposalCPT 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 | Closed Treatment Of Fracture G, Closed Treatment Of Fracture Great Toe Phalanx Orphalanges Without Manipulation Closed Treatment Of Fracture Great Toe Phalanx Or |
| 28495-CPT | Moderate | Closed Treatment Of Fracture G, Closed Treatment Of Fracture Great Toe Phalanx Orphalanges With Manipulation Closed Treatment Of Fracture Great Toe Phalanx Or |
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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