How much does Medicare pay for CPT 28272?

Medicare allowed an average of $247.81 per service and paid $192.52 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1084.44, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 28272?

Incision of toe joint capsule. It was billed 2,913 times to 1,500 Medicare beneficiaries by 70 providers in 2024.

Does 28272 pay differently in an office than a hospital?

Yes. The allowed amount averaged $278.89 in an office setting and $132.37 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 28272 most?

Podiatry, with 2,470 services from 64 clinicians. Next are Orthopedic Surgery, Ambulatory Surgical Center.

CPT 28272

Incision of toe joint capsule

$247.81Medicare-allowed amount per service, averaged across 2,913 services

Providers submitted

$1084.44

Asking price, not received

Medicare allowed

$247.81

The fee schedule figure

Medicare paid

$192.52

Balance is patient coinsurance

Providers submitted an average of $1084.44 for this code and Medicare allowed $247.81 — 4.4× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $192.52 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $278.89
Hospital / facility: $132.37

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 2,295 services were billed in an office setting and 618 in a facility.

Services: 2,913
Beneficiaries: 1,500
Providers billing it: 70
Total allowed: $721,871

What Medicare pays for CPT 28272

Across 2,913 services billed by 70 providers to 1,500 beneficiaries, Medicare allowed an average of $247.81 per service. That is 1.9 services per beneficiary, so this is a code patients typically receive more than once. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 28272

Specialty	Services	Beneficiaries	Avg allowed	Providers
Podiatry	2,470	1,359	$265.63	64
Orthopedic Surgery	224	75	$168.86	2
Ambulatory Surgical Center	219	66	$127.50	4

28272 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
Florida	362	$294.55	$232.07	9
Ohio	360	$220.95	$179.50	8
South Carolina	279	$200.21	$151.07	5
Alabama	264	$251.42	$216.06	4
Arizona	249	$194.79	$154.66	5
Illinois	200	$259.25	$224.87	4
Indiana	153	$196.73	$173.26	3
Tennessee	120	$264.04	$221.63	3
Michigan	115	$231.98	$178.29	4
North Dakota	103	$217.70	$175.89	2
New York	102	$442.75	$266.78	1
Massachusetts	77	$402.36	$279.60	2
Delaware	76	$139.51	$114.65	2
New Jersey	73	$181.10	$129.13	2
California	48	$281.22	$196.12	2
Arkansas	45	$259.61	$249.77	2
Virginia	38	$263.25	$211.93	2
Montana	32	$256.44	$204.45	1
Missouri	31	$295.04	$237.13	1
Colorado	30	$271.66	$209.07	1
Mississippi	28	$271.16	$240.00	1
North Carolina	28	$172.29	$151.14	1
Kentucky	26	$265.57	$229.99	1
New Hampshire	22	$249.15	$209.03	1
Georgia	21	$311.10	$293.39	1
Minnesota	20	$354.77	$278.38	1
Oklahoma	11	$285.08	$252.21	1

Related codes

28285Correction of toe joint deformity$553.86
28232Incision to lengthen toe tendon$235.84
28270Incision of joint capsule of foot and toe$344.55
28299Correction of bunion$1890.67
28234Incision to release foot tendon$200.33

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.