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 |
| Medicare Fee Schedule | View Medicare rates for 28496 |
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 | $425.00 | 1376538876 - THE ENDOSCOPY CENTER OF BRISTOL | 621727371 - (TN) THE ENDOSCOPY CENTER OF BRISTOL | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28496 | $811.09 | 1295933810 - KURT LANCASTER | 350593390 - DEACONESS HOSPITAL INC | MO | Anesthesiology Physician (207L00000X) |
United | 28496 | $1172.00 | 1548233794 - METAIRIE OPHTHALMOLOGY ASC LLC, AMBULATORY EYE SURGERY CENTER OF LOUISIANA | 621822003 - (LA) THE METAIRIE OPHTHALMOLOGY ASC, LLC DBA AMBULATORY EYE SURGERY CENTER | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28496 | $334.00 | 1447279369 - EYE CENTER OF NORTH FLORIDA, P.A., THE LASER & SURGERY CENTER | 522107690 - (FL) EYE CENTER OF NORTH FLORIDA, P.A. | FL | 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 | $2595.00 | 1447320213 - FREEHOLD ENDOSCOPY ASSOCIATES, LLC, ENDOSCOPY CENTER OF MONMOUTH COUNTY | 841634126 - (NJ) FREEHOLD ENDOSCOPY ASSOCIATES | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28496 | $825.00 | 1356488837 - RIDGEWOOD SURGERY AND ENDOSCOPY CENTER LLC | 204239587 - (KS) RIDGEWOOD SURGERY AND ENDOSCOPY CENTER, LLC | KS | 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 | $594.00 | 1609930676 - BAYWOOD MEDICAL ASSOCIATES, PLLC, DESERT PAIN INSTITUTE - ASC | 861006533 - (AZ) BAYWOOD MEDICAL ASSOCIATES, PLLC DBA DESERT PAIN INSTITUTE | AZ | 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 | $1300.00 | 1477108900 - CLEARWAY SURGERY CENTER OF CRESTVIEW, LLC | 842479344 - (FL) CLEARWAY SURGERY CENTER OF CRESTVIEW LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28496 | $3500.00 | 1639146541 - CENTENNIAL ASC, LLC, BAYLOR SURGICARE AT CENTENNIAL | 352199232 - (TX) CENTENNIAL ASC LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28496 | $4759.00 | 1760035158 - LEIGH ORTHOPEDIC SURGERY CENTER, LLC | 832402528 - (VA) LEIGH ORTHOPEDIC SURGERY CENTER LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28496 | $637.00 | 1023103769 - OAK LAWN ENDOSCOPY LLC | 462381028 | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28496 | $2472.00 | 1083613327 - BLOOMINGTON NORMAL HEALTHCARE, LLC | 371383015 - (IL) BLOOMINGTON-NORMAL HEALTHCARE, L.L.C. | IL | 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 |
Want to see your competitors' rates?
Start your trial today to unlock complete access to provider rates and fee schedules in your area.
Here's what you can do with PayerPrice
Renegotiate your managed care contracts
Benchmark your current rates against market averages to identify opportunities for rate optimization.
Prospect for new business using fee schedules
Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.
Integrate real-time payer data into your workflows
Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.
PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.
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.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 28496) and we'll show you how you compare in 15 minutes or less.