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 |
| Medicaid Fee Schedule | View Medicaid rates for 28496 |
National average reimbursement for CPT 28496 by major payers:
$592.50
$590.76
$610.71
$432.97
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 | Closed Treatment Of Fracture G, Closed Treatment Of Fracture Great Toe Phalanx Orphalanges Without Manipulation Closed Treatment Of Fracture Great Toe Phalanx Or |
| 28496-CPT | Moderate | Percutaneous Skeletal Fixation, Percutaneous Skeletal Fixation Of Fracture Great Toephalanx Or Phalanges With Manipulation Percutaneous Skeletal Fixation Of Fracture Great Toe |
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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