How much does Medicare pay for CPT 28285?

Medicare allowed an average of $553.86 per service and paid $439.89 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $4139.29, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 28285?

Correction of toe joint deformity. It was billed 30,630 times to 17,248 Medicare beneficiaries by 949 providers in 2024.

Does 28285 pay differently in an office than a hospital?

Yes. The allowed amount averaged $403.63 in an office setting and $558.68 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 28285 most?

Ambulatory Surgical Center, with 13,965 services from 411 clinicians. Next are Podiatry, Orthopedic Surgery.

CPT 28285

Correction of toe joint deformity

$553.86Medicare-allowed amount per service, averaged across 30,630 services

Providers submitted

$4139.29

Asking price, not received

Medicare allowed

$553.86

The fee schedule figure

Medicare paid

$439.89

Balance is patient coinsurance

Providers submitted an average of $4139.29 for this code and Medicare allowed $553.86 — 7.5× 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 $439.89 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $403.63
Hospital / facility: $558.68

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 952 services were billed in an office setting and 29,678 in a facility.

Services: 30,630
Beneficiaries: 17,248
Providers billing it: 949
Total allowed: $16,964,732

What Medicare pays for CPT 28285

Across 30,630 services billed by 949 providers to 17,248 beneficiaries, Medicare allowed an average of $553.86 per service. That is 1.8 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 28285

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ambulatory Surgical Center	13,965	8,050	$931.49	411
Podiatry	9,803	5,482	$249.97	331
Orthopedic Surgery	6,862	3,716	$219.46	207

28285 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
California	2,703	$677.70	$452.28	82
Texas	2,690	$506.07	$417.23	83
Florida	2,532	$528.71	$439.55	81
Virginia	1,404	$514.05	$421.31	42
Illinois	1,249	$665.48	$529.46	40
Arizona	1,141	$542.34	$443.50	30
South Carolina	1,135	$457.63	$389.85	33
North Carolina	1,120	$531.74	$449.45	34
Pennsylvania	1,077	$556.59	$455.68	34
Tennessee	970	$474.59	$420.49	32
New York	911	$564.69	$428.71	32
Georgia	851	$571.34	$475.23	31
Washington	750	$617.37	$485.97	19
Maryland	747	$730.79	$574.71	25
Kansas	667	$570.06	$480.01	15
Wisconsin	665	$476.36	$383.40	11
Indiana	645	$621.08	$514.92	22
Missouri	636	$530.85	$446.04	21
Ohio	616	$549.90	$464.85	20
Massachusetts	558	$477.56	$367.69	15
Arkansas	539	$420.96	$363.27	15
Iowa	520	$641.76	$544.60	14
Idaho	513	$594.23	$507.01	15
Colorado	508	$664.90	$530.48	20
Delaware	508	$575.08	$459.96	14
New Jersey	477	$693.78	$498.90	16
Louisiana	462	$507.83	$440.77	13
Mississippi	405	$449.13	$409.74	13
Oklahoma	382	$226.67	$187.99	11
Minnesota	369	$518.10	$405.97	12
Michigan	326	$665.17	$553.95	14
Utah	293	$679.15	$569.77	11
Alabama	269	$541.65	$525.01	11
Nevada	260	$465.16	$375.41	8
Connecticut	251	$667.53	$491.32	9
Nebraska	214	$373.27	$309.02	7
Kentucky	203	$204.83	$171.01	6
Oregon	175	$749.56	$578.67	6
New Mexico	150	$708.10	$632.52	5
North Dakota	143	$319.68	$281.45	4
Montana	135	$578.53	$475.46	6
South Dakota	116	$207.84	$160.34	3
Alaska	110	$522.08	$365.74	4
New Hampshire	78	$503.56	$397.00	4
Rhode Island	49	$467.17	$354.51	2
District of Columbia	32	$294.97	$166.84	1
Wyoming	29	$212.56	$189.93	1
West Virginia	27	$220.96	$175.46	1
Maine	20	$889.57	$705.02	1

Related codes

28232Incision to lengthen toe tendon$235.84
28270Incision of joint capsule of foot and toe$344.55
28272Incision of toe joint capsule$247.81
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.