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See a sample rate comparisonCPT 28635 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.
Closed Treatment Of Metatarso, Closed Treatment Of Metatarsophalangeal Joint Dislocation Requiring Anesthesia Closed Treatment Of Metatarsophalangeal Joint Dislocation
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 21 - Inpatient Hospital 24 - Ambulatory Surgical Center |
| Common Modifiers | None LT - Left side of body RT - Right side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 28635 |
| Medicaid Fee Schedule | View Medicaid rates for 28635 |
National average reimbursement for CPT 28635 by major payers:
$220.81
$232.19
$237.39
$293.11
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CPT 28635
5 of 25 sample ratesHigher to lower in this preview
UPMC Jameson, UPMC Jameson Short Procedure Unit
UPMC
$1,669.00Published rateWestern Washington Endoscopy Centers LLC, Sunrise Endoscopy Center
Western Washington Endoscopy Centers LLC
$749.00Published rateRidgecrest Specialty Surgery Center, A Professional Corporation
Ridgecrest Specialty Surgery Center A Professional Corporation
$593.00Published rateArrowhead Endoscopy And Pain Management Center LLC, Arrowhead Endoscopy Center.
Arrowhead Endoscopy And Pain Man
$535.00Published rateJaime Redman
Deaconess Hospital Inc
$144.39Published rate
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See a sample payer proposalCPT 28635 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 28635 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 28635 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 | Closed Treatment Of Metatarso, Closed Treatment Of Metatarsophalangeal Joint Dislocation Without Anesthesia Closed Treatment Ofmetatarsophalangeal Joint Dislocation |
| 28635-CPT | Moderate | Closed Treatment Of Metatarso, Closed Treatment Of Metatarsophalangeal Joint Dislocation Requiring Anesthesia Closed Treatment Of Metatarsophalangeal Joint Dislocation |
| 28636-CPT | Moderate | Percutaneous Skeletal Fixation, Percutaneous Skeletal Fixation Of Metatarsophalangeal Joint Dislocation With Manipulation Percutaneous Skeletal Fixation Of Metatarsophalangeal Joint |
| 28645-CPT | Moderate | Open Treatmn Of Metatarsophalangeal Joint Lengthen Inclu Inte, Open Treatment Of Metatarsophalangeal Joint Dislocation Includes Inte |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 28635. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 28635 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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