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See a sample rate comparisonCPT 28531 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 Sesamoid Fra, Open Treatment Of Sesamoid Fracture With Or Withoutinternal Fixation Open Treatment Of Sesamoid Fracture With Or Without
| 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 RT - Right side of body LT - Left side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 28531 |
| Medicaid Fee Schedule | View Medicaid rates for 28531 |
National average reimbursement for CPT 28531 by major payers:
$417.16
$468.95
$453.07
$324.22
Compare published rates across providers.
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CPT 28531
5 of 25 sample ratesHigher to lower in this preview
Rock Hill Surgery Center, LLC, Carolina Surgical Center
Rock Hill Surgery Center LLC
$13,579.00Published rateManchester Ambulatory Surgery Center Lp, Des Peres Square Surgery Center
$2,621.00Published rateMid Valley Surgery Center LLC
$1,400.00Published rateGut Endo, LLC, Center For Digestive Health
Gut Endo, LLC
$950.00Published rateWestglen Endoscopy Center LLC, Westglen Endoscopy Center
Westglen Endoscopy Center LLC
$622.00Published rate
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See a sample payer proposalCPT 28531 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 28531 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 28531 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 |
|---|---|---|
| 28360-CPT | High | Reconstruction, Cleft Foot |
| 28530-CPT | Low | Closed Treatment Of Sesamoid F, Closed Treatment Of Sesamoid Fractureclosed Treatm Ent Of Sesamoid Fracture |
| 28531-CPT | Moderate | Open Treatment Of Sesamoid Fra, Open Treatment Of Sesamoid Fracture With Or Withoutinternal Fixation Open Treatment Of Sesamoid Fracture With Or Without |
| 28600-CPT | Moderate | Closed Treatment Of Tarsometat, Closed Treatment Of Tarsometatarsal Joint Dislocationwithout Anesthesia Closed Treatment Of Tarsometatarsal Joint Dislocation |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 28531. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 28531 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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