CPT 28825 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 • T6 - Right foot, second digit • T1 - Left foot, second digit |
| Complexity Level | Moderate |
National average reimbursement for CPT 28825 by major payers:
$464.04
$681.99
$568.41
$634.15
| 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 28825 | ||||||
United | 28825 | $1685.00 | 1073081501 - MILFORD-FRANKLIN EYE CENTER, LLC | 43287594 - (MA) MILFORD-FRANKLIN EYE CENTER, LLC | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28825 | $912.41 | 1033190129 - MAE PHYSICIANS SURGERY CENTER, LLC | 640914895 - (MS) MAE PHYSICIAN'S SURGERY CENTER, LLC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28825 | $2101.00 | 1821421256 - MONOCACY SURGERY CENTER LLC | 462861862 - (MD) MONOCACY SURGERY CENTER | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28825 | $1273.00 | 1447258603 - SNOWDEN RIVER SURGERY CENTER LLC | 200946902 - (MD) SNOWDEN RIVER SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28825 | $7081.00 | 1174969372 - AURORA GI ASC LLC, WISCONSIN DIGESTIVE HEALTH CENTER | 461848055 - (WI) AURORA GI ASC LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28825 | $1528.00 | 1740385632 - GULF COAST OUTPATIENT SURGERY CENTER LLC, GULF COAST OUTPATIENT SURGERY CENTER | 640935301 - (MS) GULF COAST OUTPATIENT SURGERY CENTER, LLC | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28825 | $4464.00 | 1629738471 - ST VINCENT HOSPITAL-HOSPITAL SISTERS-THIRD ORDER OF ST FRANCIS, PREVEA SURGERY CENTER | 390817529 - ST VINCENT HOSPITAL-HOSPITAL SISTERS-THIRD ORDER OF ST FRANCIS | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28825 | $1911.00 | 1447269790 - WEST BEND SURGERY CENTER LLC | 391954169 - (WI) WEST BEND SURGERY CENTER LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28825 | $965.00 | 1982793709 - GASTROENTEROLOGY ASSOCIATES OF FAIRFIELD PC, ENDOSCOPY CENTER OF FAIRFIELD | 60867113 - (CT) GASTROENTEROLOGY ASSOCIATES OF FAIRFIELD, P.C. | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28825 | $4781.00 | 1396901542 - TEXAS HEALTH ARLINGTON MEMORIAL HOSPITAL | 750972805 - (TX) TEXAS HEALTH ARLINGTON MEMORIAL HOSPITAL | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28825 | $2307.00 | 1154323988 - CENTRAL VIRGINIA SURGI-CENTER LP, SURGI-CENTER OF CENTRAL VIRGINIA | 752967162 - (VA) CENTRAL VIRGINIA SURGICENTER LP | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28825 | $1188.00 | 1225039761 - ENDOSCOPY CENTER OF ST THOMAS LLC, ST THOMAS MEDICAL GROUP ENDOSCOPY CENTER | 621512411 - (TN) ENDOSCOPY CENTER OF ST THOMAS LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28825 | $1921.00 | 1417060898 - ENDOSCOPY CENTER OF COLORADO SPRINGS, LLC | 352656413 | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28825 | $970.00 | 1699328146 - ALLIANCE SURGERY CENTER, LLC | 824278461 - (MI) ALLIANCE SURGERY CENTER | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 28825 | $2388.00 | 1750823886 - LAKE ENDOSCOPY CENTER, LLC | 814225104 - (FL) LAKE ENDOSCOPY CENTER LLC | FL | 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 28825 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 28825 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 28825 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 |
|---|---|---|
| 28666-CPT | Moderate | Insertion Of Hardware To Toe Joint Dislocation With Manipulation, Accessed Through The Skin |
| 28750-CPT | High | Arthrodesis, Great Toe; Metatarsophalangeal Joint |
| 28755-CPT | Moderate | Arthrodesis, Great Toe; Interphalangeal Joint |
| 28825-CPT | Moderate | Amputation,Toe;Interphalangeal Jnt |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 28825. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 28825 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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