CPT 28555 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address high-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 • RT - Right side of body • LT - Left side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 28555 |
National average reimbursement for CPT 28555 by major payers:
$1,053.48
$1,125.77
$1,184.11
$1,408.95
| 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 28555 | ||||||
United | 28555 | $2277.00 | 1376729715 - ENDOSCOPY ASSOCIATES OF VALLEY FORGE, LLC | 161770779 - (PA) ENDOSCOPY ASSOCIATES OF VALLEY FORGE LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28555 | $4075.00 | 1467101907 - PEACE RIVER SURGERY CENTER | 853047089 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28555 | $4100.00 | 1942230024 - LUTHERVILLE ENDOSCOPY CENTER LLC | 823193901 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28555 | $4021.00 | 1881031235 - KEARNEY PAIN TREATMENT CENTER, LLC | 461807684 - (NE) KEARNEY PAIN TREATMENT CENTER LLC | NE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28555 | $1530.00 | 1831217231 - THE ENDOSCOPY CENTER AT BAINBRIDGE LLC | 205430025 - (OH) THE ENDOSCOPY CENTER AT BAINBRIDGE LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28555 | $8358.00 | 1487039517 - KC PAIN ASC, LLC | 464510621 - (MO) KC PAIN ASC LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28555 | $2911.00 | 1134182660 - CORAL SPRINGS SURGI-CENTER LTD | 650538147 - (FL) CORAL SPRINGS SURGICENTER LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28555 | $1829.00 | 1821067554 - OLD TOWN ENDOSCOPY CENTER LLC, DIGESTIVE HEALTH CENTER OF DALLAS | 752774028 - (TX) OLD TOWN ENDOSCOPY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28555 | $6492.00 | 1134262868 - NORTH SHORE SAME DAY SURGERY LLC, NORTH SHORE SURGICAL CENTER | 364120432 - (IL) NORTH SHORE SAME DAY SURGERY LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28555 | $2000.00 | 1003870825 - PINELLAS SURGERY CENTER, LLC, CENTER FOR SPECIAL SURGERY | 752563226 - (FL) PINELLAS SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28555 | $2382.00 | 1275503906 - JERVEY EYE CENTER,LLC | 582297640 | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28555 | $1427.00 | 1689669418 - DIAGNOSTIC ENDOSCOPY LLC | 223750394 - (CT) DIAGNOSTIC ENDOSCOPY LLC | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28555 | $3094.00 | 1821167479 - EVERGREEN EYE CENTER, PLLC, EVERGREEN EYE SURGERY CENTER | 911628032 - (WA) EVERGREEN EYE CENTER, INC. P.S. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28555 | $2788.00 | 1194970418 - PACIFIC CATARACT AND LASER INSTITUTE INC PC | 911394965 - PACIFIC CATARACT AND LASER INSTITUTE, INC., PC | NM | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28555 | $812.07 | 1841290103 - CENTRAL FLORIDA EYE INSTITUTE PL | 421621290 - (FL) CENTRAL FLORIDA EYE INSTITUTE PL | 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 28555 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 28555 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 28555 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 |
|---|---|---|
| 28540-CPT | Moderate | Closed Treatment Of Tarsal Bone Dislocation, Other Than Talotarsal; Without Anesthesia |
| 28545-CPT | Moderate | Closed Treatment Of Tarsal Bone Dislocation, Other Than Talotarsal; Requiring Anesthesia |
| 28546-CPT | Moderate | Percutaneous Skeletal Fixation Of Tarsal Bone Dislocation, Other Than Talotarsal, With Manipulation |
| 28555-CPT | High | Open Treatment Of Closed Or Open Tarsal Bone Dislocation, With Or Without Internal Or External Skeletal Fixation |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 28555. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 28555 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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