CPT 28505 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 | • 24 - Ambulatory Surgical Center • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • T5 - Right foot, great toe • TA - Left foot, great toe |
| Complexity Level | Moderate |
National average reimbursement for CPT 28505 by major payers:
$855.88
$862.31
$900.27
$1,067.06
| 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 28505 | ||||||
United | 28505 | $1968.00 | 1760907919 - BANNER SUN CITY WEST SURGERY CENTER LLC | 901182684 - (AZ) BANNER SUN CITY WEST SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28505 | $1117.00 | 1194163576 - CEC SURGICAL SERVICES, LLC | 461929574 - (MD) CEC SURGICAL SERVICES LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28505 | $1554.00 | 1891049441 - ISLAND DIGESTIVE HEALTH CENTER, LLC | 452411095 - (NY) ISLAND DIGESTIVE HEALTH CENTER LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28505 | $2044.00 | 1508304692 - THE REGENTS OF THE UNIVERSITY OF CALIFORNIA, UCLA DEPT OF MEDICINE | 954373071 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28505 | $1125.00 | 1306958103 - NEI AMBULATORY SURGERY CENTER INC PC | 232429169 - (PA) NEI AMBULATORY SURGERY CENTER INC PC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28505 | $4599.00 | 1619974219 - ST. JOSEPH'S SURGERY CENTER LP | 201019390 - (CA) ST JOSEPHS SURGERY CENTER LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28505 | $965.00 | 1982793709 - GASTROENTEROLOGY ASSOCIATES OF FAIRFIELD PC, ENDOSCOPY CENTER OF FAIRFIELD | 60867113 - (CT) GASTROENTEROLOGY ASSOCIATES OF FAIRFIELD, P.C. | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28505 | $1414.00 | 1437250248 - GEORGIA SURGICAL CENTER ON PEACHTREE, LLC | 582394271 - (GA) GEORGIA SURGICAL CENTER ON PEACHTREE LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28505 | $1026.00 | 1043216617 - TRIAD SURGERY CENTER LLC, TRIAD EYE MEDICAL CLINIC AND CATARACT INSTITUTE PLLC | 473510624 | OK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28505 | $2859.00 | 1295246981 - SURGCENTER OF SAN DIEGO, LLC, ADVANCED SURGERY CENTER OF NORTH COUNTY | 820615296 - (CA) SURGCENTER OF SAN DIEGO | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28505 | $4617.00 | 1477017648 - CONNECTICUT ORTHOPAEDIC SURGERY CENTER, LLC | 832570191 - (CT) CONNECTICUT ORTHOPAEDIC SURGERY CENTER, LLC | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28505 | $1500.00 | 1902850571 - SDM ASC LLC, DAYTIME OUTPATIENT SURGERY CENTER | 752816595 - (TX) SDM ASC LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28505 | $1369.00 | 1831746007 - GC SURGERY CENTER LLC | 823013393 - (GA) GC SURGERY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28505 | $770.00 | 1568556488 - SUNCOAST EYE CENTER PA, SUNCOAST SURGERY INSTITUTE | 592337219 - (FL) SUNCOAST EYE CENTER PA | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28505 | $4588.00 | 1003897448 - NORTHWEST SURGERY CENTER LLC, FOOT & ANKLE SURGERY CENTER | 208754071 | IN | 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 28505 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 28505 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 28505 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 |
|---|---|---|
| 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 |
| 28496-CPT | Moderate | Treatment Of Closed Fracture Great Toe, Phalanx Or Phalanges; With Manipulation And Percutaneous Pinning |
| 28505-CPT | Moderate | Open Treatment Of Closed Or Open Fracture Great Toe, Phalanx Or Phalanges, With Or Without Internal Or External Skele |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 28505. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 28505 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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