CPT 28630 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 | • 23 - Emergency Room • 11 - Office |
| Common Modifiers | • None • 54 - Surgical Care Only • T5 - Right foot, great toe |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 28630 |
National average reimbursement for CPT 28630 by major payers:
$201.60
$203.84
$209.44
$258.40
| 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 28630 | ||||||
United | 28630 | $112.00 | 1124091897 - PADUCAH OPHTHALMOLOGY ASC LLC, THE EYE SURGERY CENTER OF PADUCAH | 943428567 - (KY) PADUCAH OPHTHALMOLOGY ASC LLC | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28630 | $566.00 | 1245711803 - SURGCENTER CLEARWATER, LLC, SURGCENTER DUNEDIN | 823682684 - (FL) SURGCENTER CLEARWATER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28630 | $906.00 | 1922160357 - ARAPAHOE ENDOSCOPY CENTER PARTNERSHIP PLLP | 472388780 | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28630 | $127.26 | 1518487925 - GABRIELLE STEELE | 350593390 - DEACONESS HOSPITAL INC | IN | Physician Assistant (363A00000X) |
United | 28630 | $553.00 | 1518995513 - AFFILIATED ENDOSCOPY CENTERS, LLC | 411923237 - (MN) AFFILIATED ENDOSCOPY CENTERS LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28630 | $162.00 | 1558926931 - WELLNESS AMBULATORY SURGERY CENTER, LLC | 810848308 - (TX) WELLNESS AMBULATORY SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28630 | $190.00 | 1568423945 - NW AMBULATORY SURGERY CENTER LLP, NW SURGERY CENTER | 383693604 - (TX) NW AMBULATORY SURGERY CENTER LLP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28630 | $55.00 | 1740264811 - EYES OF YORK SURGICAL CENTER LLC | 200930310 - (PA) EYES OF YORK SURGICAL CENTER LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28630 | $574.00 | 1922141647 - RIVER NORTH SAME DAY SURGERY LLC, NORTHWESTERN MEDICINE SURGERY CENTER RIVER NORTH | 364120432 - (IL) NORTH SHORE SAME DAY SURGERY LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28630 | $240.00 | 1346213634 - SARASOTA ENDOSCOPY ASC LLC, BAYVIEW ENDOSCOPY CENTER | 621806248 - (FL) THE SARASOTA ENDOSCOPY ASC, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28630 | $574.00 | 1720325160 - SURGCENTER OF DEER VALLEY, LLC | 461512703 - (AZ) SURGCENTER OF DEER VALLEY LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28630 | $150.00 | 1770796757 - LAPEER COUNTY SURGERY CENTER LLC | 202918877 - (MI) LAPEER COUNTY SURGERY CENTER L | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28630 | $368.00 | 1700492170 - MERCY HEALTH BOARDMAN SURGERY | 863462441 - (OH) BSMH AMBULATORY VENTURES II LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28630 | $1394.00 | 1023359627 - THE EMORY CLINIC INC., EMORY AESTHETIC CENTER | 582030692 - EMORY UNIVERSITY | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28630 | $95.00 | 1205978780 - MOUNTAIN HOME SURGERY CENTER | 454157268 | AR | 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 28630 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 28630 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 28630 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 |
|---|---|---|
| 28630-CPT | Moderate | *Treatment Of Closed Metatarsophalangeal Joint Dislocation; Without Anesthesia |
| 28635-CPT | Moderate | *Treatment Of Closed Metatarsophalangeal Joint Dislocation; Requiring Anesthesia |
| 28636-CPT | Moderate | Percutaneous Skeletal Fixation Of Metatarsophalangeal Joint Dislocation, With Manipulation |
| 28645-CPT | Moderate | Open Treatment Of Metatarsophalangeal Joint Dislocation, Includes Internal Fixation, When Performed |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 28630. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 28630 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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