CPT 28636 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 • 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 28636 |
National average reimbursement for CPT 28636 by major payers:
$408.45
$413.13
$421.85
$543.29
| 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 28636 | ||||||
United | 28636 | $4608.00 | 1033802509 - FOX VALLEY SURGERY CENTER LLC | 922792459 - (WI) FOX VALLEY SURGERY CENTER LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28636 | $1678.00 | 1124093588 - UROLOGY SURGERY CENTER OF SAVANNAH, LLLP, UROLOGY SURGERY CENTER, LLP | 582511751 - (GA) UROLOGY SURGERY CENTER OF SAVANNAH LLLP | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28636 | $1514.00 | 1689814998 - PUGET SOUND SURGICAL CLINIC INC | 911687859 - (WA) PUGET SOUND SURGICAL CENTER LLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28636 | $1066.00 | 1295897106 - WESTMONT SURGERY CENTER LLC, SALT CREEK SURGERY CENTER | 364419691 - WESTMONT SURGERY CENTER, LLC DBA SALT CREEK SURGERY CENTER | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28636 | $1363.00 | 1699767210 - SOUTHERN OKLAHOMA SURGICAL CENTER INC | 731205988 - (OK) SOUTHERN OKLAHOMA SURGICAL CENTER, INC. | OK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28636 | $7169.00 | 1659839686 - AURORA SURGERY CENTERS, LLC | 811401714 - (WI) AURORA SURGERY CENTERS LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28636 | $2307.00 | 1720085277 - ROSWELL SURGERY CENTER LLC, ROSWELL SURGERY CENTER | 582577112 - (GA) ROSWELL SURGERY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28636 | $770.00 | 1093974602 - EVERGREEN ENDOSCOPY CENTER, LLC | 412211130 - (CT) EVERGREEN ENDOSCOPY CENTER LLC | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28636 | $1525.00 | 1902447386 - SEATTLE PAIN RELIEF PLLC, FEDERAL WAY AMBULATORY SURGICAL FACILITY | 455527273 - (WA) SEATTLE PAIN RELIEF PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28636 | $1568.00 | 1851552483 - SKYLINE SURGERY CENTER, LLC, SKYLINE SURGERY CENTER INC | 262792159 - (ID) SKYLINE SURGERY CENTER, LLC | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28636 | $2859.00 | 1942851639 - NORTHERN MICHIGAN SURGICAL SUITES, LLC | 830670803 - (MI) NORTHERN MICHIGAN SURGICAL SUITES, LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28636 | $5402.00 | 1457948630 - METHODIST AMBULATORY SURGERY CENTER OF LANDMARK, LLC | 842492174 - (TX) METHODIST AMBULATORY SURGERY CENTER OF LANDMARK LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28636 | $1100.00 | 1871941468 - AMBULATORY SURGERY CENTER FOR PELVIC NEURO SCIENCE LLC | 812463581 - (MD) AMBULATORY SURGERY CENTER FOR PELVIC NEURO SCIENCE LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28636 | $1600.00 | 1932496908 - CONCOURSE DIAGNOSTIC SURGERY CENTER, LLC, CONCOURSE DIAGNOSTIC SURGERY CENTER,LLC | 273205326 - (CA) CONCOURSE DIAGNOSTIC & SURGERY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28636 | $1273.00 | 1336547421 - ASSOCIATED EYE SURGICAL CENTER LLC | 472453025 | KS | 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 28636 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 28636 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 28636 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 28636. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 28636 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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