CPT 28725 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 | • 22 - On Campus Outpatient Hospital • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • RT - Right side of body • LT - Left side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 28725 |
National average reimbursement for CPT 28725 by major payers:
$1,064.75
$1,066.83
$1,107.68
$1,330.57
| 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 28725 | ||||||
United | 28725 | $6492.00 | 1730713439 - FLORIDA SPRINGS SURGERY CENTER LLC | 832895293 - (FL) FLORIDA SPRINGS SURGERY CENTER L | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28725 | $5200.00 | 1356969703 - VASCULAR LABS OF THE ROCKIES ASC, LLC | 850780051 - (CO) VASCULAR LABS OF THE ROCKIES ASC LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28725 | $6087.00 | 1003813221 - UNIVERSITY SURGERY CENTER LTD | 742894406 - (FL) UNIVERSITY SURGERY CENTER LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28725 | $3760.00 | 1316678311 - OPTUM PEAK ENDOSCOPY CENTER LLC | 880934943 - (CO) OPTUM PEAK ENDOSCOPY CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28725 | $4500.00 | 1285083477 - GEORGIA INTERVENTIONAL PAIN | 810948119 - (GA) GEORGIA INTERVENTIONAL PAIN | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28725 | $2316.00 | 1962815746 - CAPITOL STREET SURGERY CENTER LLC | 465061657 - (IN) CAPITOL STREET SURGERY CENTER LL | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28725 | $1700.00 | 1225096134 - GAINESVILLE EYE CENTER, LLC | 201895224 - (GA) GAINESVILLE EYE CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28725 | $6365.00 | 1750823886 - LAKE ENDOSCOPY CENTER, LLC | 814225104 - (FL) LAKE ENDOSCOPY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28725 | $2114.00 | 1396213294 - UH NORTH RIDGEVILLE ENDOSCOPY CENTER LLC | 831320776 - (OH) UH NORTH RIDGEVILLE ENDOSCOPY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28725 | $8180.00 | 1154460525 - VIRGINIA MASON MEDICAL CENTER, VIRGINIA MASON LYNNWOOD ASC | 910565539 - (WA) VIRGINIA MASON MEDICAL CENTER | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28725 | $1176.00 | 1285736207 - PODIATRY GROUP OF ANNAPOLIS AMBULATORY SURGICAL CENTER, PODIATRY GROUP OF ANNAPOLIS AMBULATORY SURGICAL CENTER LLC | 522197193 - (MD) PODIATRY GROUP OF ANNAPOLIS AMBULATORY SURGICAL CENTER | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28725 | $2276.00 | 1720081664 - HEATON LASER AND SURGERY CENTER L L C | 752752100 - (TX) HEATON LASER AND SURGERY CENTER L L C | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28725 | $1371.95 | 1013117621 - MATTHEW GILBERT | 350593390 - DEACONESS HOSPITAL INC | IN | Emergency Medicine Physician (207P00000X) |
United | 28725 | $630.35 | 1811614720 - SIERRA SIGLER | 350593390 - DEACONESS HOSPITAL INC | IL | Nurse Practitioner (363L00000X) |
United | 28725 | $1371.95 | 1205539012 - HANNAH WHITE | 350593390 - DEACONESS HOSPITAL INC | IN | Physician Assistant (363A00000X) |
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 28725 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 28725 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 28725 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 |
|---|---|---|
| 28705-CPT | High | Fusion Of All Bones Of The Ankle And Hindfoot |
| 28715-CPT | High | Fusion Of Three Major Bones Of The Hindfoot |
| 28725-CPT | High | Subtalar Arthrodesis (Includes Grice Type Procedure) |
| 28737-CPT | Moderate | Arthrodesis, With Tendon Lengthening And Advancement, Midtarsal, Tarsal Navicular-Cuneiform (Eg, Miller Type Procedure) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 28725. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 28725 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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