CPT 28605 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 | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 59 - Distinct Procedural Service • RT - Right side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 28605 |
National average reimbursement for CPT 28605 by major payers:
$416.11
$420.74
$449.92
$557.18
| 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 28605 | ||||||
United | 28605 | $107.00 | 1326176215 - ENDOSCOPY CENTER OF ST THOMAS LLC, NGS ENDOSCOPY CENTER | 621512411 - (TN) ENDOSCOPY CENTER OF ST THOMAS LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28605 | $263.00 | 1508862624 - NOVAMED SURGERY CENTER OF DENVER LLC, CHERRY HILLS SURGERY CENTER | 841672152 - (CO) NOVAMED SURGERY CENTER OF DENVER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28605 | $566.00 | 1619637543 - GAB ENDOSCOPY CENTER LLC | 372021101 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28605 | $547.00 | 1891049441 - ISLAND DIGESTIVE HEALTH CENTER, LLC | 452411095 - (NY) ISLAND DIGESTIVE HEALTH CENTER LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28605 | $658.00 | 1346244845 - LAKELAND SURGICAL & DIAGNOSTIC CENTER LLP | 934728316 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28605 | $601.00 | 1518634732 - MEDSTAR HEALTH ENDOSCOPY CENTER | 872341245 - (MD) MEDSTAR HEALTH ENDOSCOPY CENTER | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28605 | $245.00 | 1285120352 - AKDHC SURGERY CENTER, LLC | 753052504 | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28605 | $566.00 | 1790241073 - HSS PALM BEACH AMBULATORY SURGERY CENTER, LLC | 301015589 - (FL) HSS PALM BEACH AMBULATORY SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28605 | $90.00 | 1215400320 - SURGERY CENTER AT GATEWAY LLC | 823763830 - (MI) SURGERY CENTER AT GATEWAY LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28605 | $104.00 | 1215118930 - DELPHOS AMBULATORY SURGERY CENTER INC, DELPHOS ASC | 208412630 - (OH) DELPHOS AMBULATORY SURGERY CENTER INC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28605 | $200.00 | 1255676920 - NORTHPOINTE SURGICAL CENTER, LLC | 461487986 - (UT) NORTHPOINTE SURGICAL CENTER LLC | UT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28605 | $191.00 | 1144970112 - SONORAN ENDOSCOPY CENTER LLC | 852760027 - (AZ) SONORAN ENDOSCOPY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28605 | $206.00 | 1528462819 - THE ENDOSCOPY CENTER, INC. | 471907162 - (CA) THE ENDOSCOPY CENTER INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28605 | $365.00 | 1629145685 - IDAHO EYE CENTER PA, IDAHO EYE SURGICENTER | 820379995 - (ID) IDAHO EYE CENTER, P.A. | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28605 | $329.00 | 1295710002 - SCOTTSDALE EYE SURGERY CENTER, P.C | 860566687 - (AZ) SCOTTSDALE EYE SURGERY CENTER | AZ | 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 28605 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 28605 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 28605 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 |
|---|---|---|
| 28600-CPT | Moderate | Closed Treatment Of Tarsometatarsal Joint Dislocation; Without Anesthesia |
| 28605-CPT | Moderate | Treatment Of Closed Tarsometatarsal Joint Dislocation; Requiring Anesthesia |
| 28606-CPT | Moderate | Insertion Of Hardware To Foot Joint Dislocation With Manipulation, Accessed Through The Skin Of The |
| 28615-CPT | High | Open Treatment Of Closed Or Open Tarsometatarsal Joint Dislocation, With Or Without Internal Or External Skeletal Fixa |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 28605. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 28605 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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