CPT 28530 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 • RT - Right side of body • LT - Left side of body |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 28530 |
National average reimbursement for CPT 28530 by major payers:
$158.15
$152.96
$156.34
$198.74
| 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 28530 | ||||||
United | 28530 | $622.26 | 1710007596 - CANONSBURG GENERAL HOSPITAL | 251737079 - (PA) HIGHMARK HEALTH | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28530 | $125.00 | 1659420727 - THE ENDOSCOPY CENTER, INC. | 460450119 - (SD) THE ENDOSCOPY CENTER INC | SD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28530 | $330.00 | 1255493482 - GRAYSTONE EYE SURGERY CENTER OF HICKORY, LP, GRAYSTONE EYE SURGERY CENTER | 205740206 | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28530 | $87.00 | 1922071315 - SENECA PA ASC LLC, THE SURGERY AND LASER CENTER | 621806254 - (PA) SENECA PA ASC, LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28530 | $1096.00 | 1073613162 - ROCKY MOUNTAIN SURGERY CENTER LLC | 870699657 - (CO) ROCKY MOUNTAIN SURGERY CENTER, LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28530 | $35.00 | 1306005343 - DIGESTIVE HEALTH SPECIALISTS, PA | 561242980 - (NC) DIGESTIVE HEALTH SPECIALISTS, P.A. | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28530 | $4613.00 | 1679892913 - BELTWAY SURGERY CENTERS, L.L.C. | 352072586 | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28530 | $342.00 | 1609871847 - THE SURGERY CENTER, LLC | 582520623 - (GA) THE SURGERY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28530 | $464.60 | 1740442615 - CENTER FOR ADVANCED REPRODUCTIVE SERVICES, PC, AMBULATORY SURGICAL CENTER AT REPRODUCTIVE SERVICES | 61522659 - (CT) CENTER FOR ADVANCED REPRODUCTIVE SERVICES, P.C. | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28530 | $160.00 | 1881687614 - TURKS HEAD SURGERY CENTER LLC | 200184603 - (PA) TURK'S HEAD SURGERY CENTER, L.L.C. | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28530 | $2079.00 | 1336391085 - MEMORIAL HERMANN SURGERY CENTER KINGSLAND LLC, MEMORIAL HERMANN SURGERY CENTER KINGSLAND | 263464776 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28530 | $125.00 | 1992343610 - VANCE THOMPSON VISION SURGERY CENTER NE, LLC | 843878941 | NE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28530 | $1708.00 | 1629705231 - SURGICAL CENTER OF SOUTH JERSEY LIMITED PARTNERSHIP | 222709324 | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28530 | $500.00 | 1598372963 - ALLIANCE SURGERY CENTER AT PEACHTREE CITY LLC | 853147678 - (GA) ALLIANCE SURGERY CENTER AT PEACHTREE CITY LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28530 | $61.00 | 1679704456 - ORLANDO ORTHOPAEDIC OUTPATIENT SURGERY CENTER LLC | 264122762 - (FL) ORLANDO ORTHOPAEDIC OUTPATIENT SURGERY CENTER LLC | FL | 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 28530 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 28530 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 28530 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 |
| 28530-CPT | Low | Closed Treatment Of Broken Small Bone In Tendon Attached To Great Toe |
| 28531-CPT | Moderate | Open Treatment Of Fracture Of Fracture Of A Small Bone Within A Tendon In The Foot |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 28530. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 28530 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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