CPT 28515 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 | • 11 - Office • 23 - Emergency Room |
| Common Modifiers | • None • 54 - Surgical Care Only • T4 - Left foot, fifth digit |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 28515 |
National average reimbursement for CPT 28515 by major payers:
$224.86
$212.17
$226.16
$276.41
| 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 28515 | ||||||
United | 28515 | $132.69 | 1518487925 - GABRIELLE STEELE | 350593390 - DEACONESS HOSPITAL INC | IN | Physician Assistant (363A00000X) |
United | 28515 | $5213.00 | 1164486809 - SAINT LUKE'S SURGICENTER | 470853481 - (MO) SAINT LUKES SURGICENTER | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28515 | $132.69 | 1275020612 - STACEY KUDER | 350593390 - DEACONESS HOSPITAL INC | IN | Clinical Social Worker (1041C0700X) |
United | 28515 | $163.00 | 1003887225 - CENTRAL TEXAS ENDOSCOPY CENTER LLC, CENTRAL TEXAS ENDOSCOPY CENTER | 742863853 - (TX) CENTRAL TEXAS ENDOSCOPY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28515 | $327.00 | 1710321328 - VALLEY PHYSICIANS SURGERY CENTER AT NORTHRIDGE LLC | 800864336 - (CA) VALLEY PHYSICIANS SURGERY CENTER OF NORTHRIDGE LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28515 | $531.00 | 1861905176 - BERKSHIRE EYE, LLC | 352609003 | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28515 | $555.00 | 1841395894 - FRANKLIN ENDOSCOPY CENTER, LLC, FRANKLIN ENDOSCOPY CENTER | 383730672 - (TN) FRANKLIN ENDOSCOPY CENTER LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28515 | $344.00 | 1255604534 - BARNET DULANEY PERKINS EYE CENTER, PC, BDPEC TUCSON | 562589722 - BARNET DULANEY PERKINS EYE CENTER PLLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28515 | $574.00 | 1144954165 - ADVANCED SURGICAL CARE OF LUTZ, LLC, ADVANCED SURGICAL CARE OF NEW TAMPA | 871390521 - (FL) ADVANCED SURGICAL CARE OF LUTZ LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28515 | $850.00 | 1043679509 - NORTHPOINTE SURGICAL SUITES, LLC | 472788542 - (OH) NORTHPOINTE SURGICAL SUITES, LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28515 | $237.00 | 1669405684 - PACIFICOAST AMBULATORY SURGICENTER, LLC., PACIFIC COAST AMBULATORY SURGICENTER | 474003673 - (CA) PACIFICOAST AMBULATORY SURGICENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28515 | $600.00 | 1477792828 - PRECISION SURGICENTER LLC | 262185162 - (CA) PRECISION SURGICENTER, LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28515 | $115.00 | 1457545980 - SAND LAKE SURGERY CENTER, LP, SAND LAKE SURGERY CENTER | 273787593 - (FL) SAND LAKE SURGICENTER, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28515 | $200.00 | 1497367262 - SNKS ENTERPRISES LLC, SOL VALLEY SURGERY CENTER | 364932587 - (AZ) SNKS ENTERPRISES LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28515 | $288.79 | 1851736268 - STEVEN VONFROLIO | 350593390 - DEACONESS HOSPITAL INC | IN | Hospitalist Physician (208M00000X) |
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 28515 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 28515 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 28515 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 |
|---|---|---|
| 28510-CPT | Low | Treatment Of Closed Fracture, Phalanx Or Phalanges, Other Than Great Toe; Without Manipulation, Each |
| 28515-CPT | Moderate | Treatment Of Closed Fracture, Phalanx Or Phalanges, Other Than Great Toe; With Manipulation, Each |
| 28525-CPT | Moderate | Open Treatment Of Fracture, Phalanx Or Phalanges, Other Than Great Toe, Includes Internal Fixation, When Performed, Each |
| 28530-CPT | Low | Closed Treatment Of Broken Small Bone In Tendon Attached To 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 28515. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 28515 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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