CPT 28525 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 • T6 - Right foot, second digit • T9 - Right foot, fifth digit |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 28525 |
National average reimbursement for CPT 28525 by major payers:
$729.61
$742.83
$763.63
$925.25
| 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 28525 | ||||||
United | 28525 | $515.00 | 1518155811 - THE ALTAMONTE SPRINGS FL ENDOSCOPY ASC LLC, PALM ENDOSCOPY CENTER | 260289067 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28525 | $777.00 | 1922104710 - OAKS SURGERY CENTER LP | 753019861 - (CA) OAKS SURGERY CENTER LP THE OAK | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28525 | $1282.00 | 1669585964 - WEST LAS VEGAS SURGERY CENTER,LLC, VALLEY VIEW SURGERY CENTER | 201898649 - (NV) WEST LAS VEGAS SURGERY CENTER LLC D/B/A VALLEY VIEW SURGERY CENTER | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28525 | $1015.21 | 1548557721 - JASON BOOTH | 350593390 - DEACONESS HOSPITAL INC | IN | Anesthesiology Physician (207L00000X) |
United | 28525 | $1030.00 | 1386618783 - LEWES DE ENDOSCOPY ASC LLC, SEASIDE ENDOSCOPY PAVILION | 562299727 - (DE) LEWES DE ENDOSCOPY ASC LLC | DE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28525 | $1400.00 | 1649893934 - SIMI VALLEY SURGERY CENTER INC | 841997544 - (CA) SIMI VALLEY SURGERY CENTER INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28525 | $4464.00 | 1629738471 - ST VINCENT HOSPITAL-HOSPITAL SISTERS-THIRD ORDER OF ST FRANCIS, PREVEA SURGERY CENTER | 390817529 - ST VINCENT HOSPITAL-HOSPITAL SISTERS-THIRD ORDER OF ST FRANCIS | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28525 | $432.00 | 1659516375 - BROOKLYN ENDOSCOPY SC, LLC, GNYESC | 205479673 - (NY) BROOKLYN ENDOSCOPY SC LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28525 | $1026.00 | 1639566318 - TRIAD SURGERY CENTER, LLC | 473510624 | OK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28525 | $2353.00 | 1215116611 - UPPER BAY SURGERY CENTER, LLC | 205547410 - (MD) UPPER BAY SURGERY CENTER, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28525 | $2000.00 | 1396832549 - GENESEE CARE L.L.C., THE SURGERY CENTER OF GENESEE COUNTY | 383242685 - (MI) GENESEE CARE LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28525 | $1266.00 | 1215988308 - MIAMI HAND CENTER, LLC | 650811130 - (FL) MIAMI HAND CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28525 | $2388.00 | 1174592844 - AUDUBON AMBULATORY SURGERY CENTER LLC, AUDUBON SURGERY CENTER | 841482638 - (CO) AUDUBON AMBULATORY SURGERY CENTER, LLC. | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28525 | $730.00 | 1497727119 - DIGESTIVE ENDOSCOPY CENTER LLC, DIGESTIVE ENDOSCOPY CENTER | 311508446 - (OH) DIGESTIVE ENDOSCOPY CENTER, LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28525 | $818.00 | 1497347934 - INTEGRIS DDSI ENDOSCOPY CENTERS LLC | 854253589 | OK | 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 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 | 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 |
| 28510-CPT | Low | Treatment Of Closed Fracture, Phalanx Or Phalanges, Other Than Great Toe; Without Manipulation, Each |
| 28525-CPT | Moderate | 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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