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See a sample rate comparisonCPT 28525 Fee Schedule
Last Verified: October 2026
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.
Open Treatment Of Fracture Ph, Open Treatment Of Fracture Phalanx Or Phalanges Other Than Great Toe Includes Internal Fixation When Performed Each
| 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 T6 - Right foot, second digit T9 - Right foot, fifth digit |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 28525 |
| Medicaid Fee Schedule | View Medicaid rates for 28525 |
National average reimbursement for CPT 28525 by major payers:
$729.61
$742.83
$763.63
$663.18
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CPT 28525
5 of 25 sample ratesHigher to lower in this preview
Performance Health Surgicenter, LLC
Performance Health Surgicenter LLC
$6,651.00Published rateOrthomidwest Surgery Center Beloit, LLC
Orthomidwest Surgery Center Beloit LLC
$2,289.00Published rateLewes De Endoscopy Asc LLC, Seaside Endoscopy Pavilion
Lewes De Endoscopy Asc LLC
$1,030.00Published rateFemi-Care Surgery Center, LLC
Femicare Surgery Center LLC
$619.00Published rateBrooklyn Endoscopy Sc, LLC, Gnyesc
Brooklyn Endoscopy Sc LLC
$432.00Published rate
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See a sample payer proposalCPT 28525 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 28525 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 28525 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 | Closed Treatment Of Fracture G, Closed Treatment Of Fracture Great Toe Phalanx Orphalanges Without Manipulation Closed Treatment Of Fracture Great Toe Phalanx Or |
| 28495-CPT | Moderate | Closed Treatment Of Fracture G, Closed Treatment Of Fracture Great Toe Phalanx Orphalanges With Manipulation Closed Treatment Of Fracture Great Toe Phalanx Or |
| 28510-CPT | Low | Closed Treatment Of Fracture, Closed Treatment Of Fracture Phalanx Or Phalanges Otherthan Great Toe Without Manipulation Each Closed Treatment Of Fracture Phalanx Or Phalange S Other |
| 28525-CPT | Moderate | Open Treatment Of Fracture Ph, Open Treatment Of Fracture Phalanx Or Phalanges Other Than Great Toe Includes Internal Fixation When Performed Each |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 28525. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 28525 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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