CPT 28496 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 | • 22 - On Campus Outpatient Hospital • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • T5 - Right foot, great toe • TA - Left foot, great toe |
| Complexity Level | Moderate |
National average reimbursement for CPT 28496 by major payers:
$592.50
$590.76
$610.71
$772.20
| 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 28496 | ||||||
United | 28496 | $1400.00 | 1912412420 - GALEA CENTER, LLC., GALEA CENTER FOR ADVANCED SURGERY | 821939476 - (CA) GALEA CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28496 | $2388.00 | 1255361259 - CENTRAL JERSEY SURGERY CENTER LLC, CENTRAL JERSEY SURGERY CENTER | 582352848 - (NJ) CENTRAL JERSEY SURGERY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28496 | $990.00 | 1003855594 - OHIO EYE ASSOCIATES, INC., OHIO EYE ASSOCIATES EYE SURGERY & LASER CENTER | 341171920 - (OH) OHIO EYE ASSOCIATES, INC. | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28496 | $2166.00 | 1306135298 - DMG PAIN MANAGEMENT SURGERY CENTER, LLC | 271322187 - (IL) DMG PAIN MANAGEMENT SURGERY CENTER LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28496 | $530.00 | 1417118241 - DIGESTIVE HEALTH COMPLEX,INC | 262808532 | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28496 | $6245.00 | 1750415220 - TEXAS HEALTH HARRIS METHODIST HOSPITAL CLEBURNE | 751977850 - (TX) TEXAS HEALTH HARRIS METHODIST HOSPITAL CLEBURNE | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28496 | $1026.00 | 1043216617 - TRIAD SURGERY CENTER LLC, TRIAD EYE MEDICAL CLINIC AND CATARACT INSTITUTE PLLC | 473510624 | OK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28496 | $2307.00 | 1942851639 - NORTHERN MICHIGAN SURGICAL SUITES, LLC | 830670803 - (MI) NORTHERN MICHIGAN SURGICAL SUITES, LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28496 | $1339.00 | 1609815075 - ORTHOATLANTA SURGERY CENTER OF FAYETTEVILLE, LLC | 202961633 - (GA) ORTHOATLANTA SURGERY CENTER OF FAYETTEVILLE LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28496 | $2025.00 | 1730401571 - CHILDRENS SURGERY CENTER LLC, ADVENTHEALTH SURGERY CENTER MAITLAND | 262389638 - (FL) CHILDRENS SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28496 | $1258.00 | 1174938344 - SPECIALTY SURGERY CENTER, LLC | 455554765 - (MS) SPECIALTY SURGERY CENTER LLC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28496 | $1284.00 | 1932132065 - AMBULATORY SURGICAL CTR OF AIKEN LLC, THE SURGERY CENTER OF AIKEN | 830879278 | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28496 | $1156.00 | 1841342789 - SURGERY CENTER JV, THE SURGERY CENTER OF HUNTSVILLE | 621230866 - (AL) THE SURGERY CENTER OF HUNTSVILLE | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28496 | $1121.00 | 1184600736 - MERIDIAN SURGERY CENTER, LLC | 300160065 - (MS) MERIDIAN SURGERY CENTER, LLC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28496 | $1819.00 | 1497752745 - ORTHOPEDIC SOUTH SURGICAL PARTNERS, LLC, ORTHOPAEDIC SOUTH SURGICAL CENTER | 260008898 - (GA) ORTHOPEDIC SOUTH SURGICAL PARTNERS 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 28496 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 28496 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 28496 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 |
| 28496-CPT | Moderate | Treatment Of Closed Fracture Great Toe, Phalanx Or Phalanges; With Manipulation And Percutaneous Pinning |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 28496. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 28496 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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