How much does Medicare pay for CPT 28470?

Medicare allowed an average of $212.63 per service and paid $163.06 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $925.79, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 28470?

Closed treatment of broken bone in forefoot or midfoot. It was billed 2,934 times to 2,716 Medicare beneficiaries by 161 providers in 2024.

Does 28470 pay differently in an office than a hospital?

Yes. The allowed amount averaged $212.82 in an office setting and $203.01 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 28470 most?

Podiatry, with 1,445 services from 77 clinicians. Next are Orthopedic Surgery, Physician Assistant, Nurse Practitioner.

CPT 28470

Closed treatment of broken bone in forefoot or midfoot

$212.63Medicare-allowed amount per service, averaged across 2,934 services

Providers submitted

$925.79

Asking price, not received

Medicare allowed

$212.63

The fee schedule figure

Medicare paid

$163.06

Balance is patient coinsurance

Providers submitted an average of $925.79 for this code and Medicare allowed $212.63 — 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 $163.06 (77%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $212.82
Hospital / facility: $203.01

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. 2,876 services were billed in an office setting and 58 in a facility.

Services: 2,934
Beneficiaries: 2,716
Providers billing it: 161
Total allowed: $623,856

What Medicare pays for CPT 28470

Across 2,934 services billed by 161 providers to 2,716 beneficiaries, Medicare allowed an average of $212.63 per service. 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 28470

Specialty	Services	Beneficiaries	Avg allowed	Providers
Podiatry	1,445	1,342	$213.38	77
Orthopedic Surgery	1,314	1,204	$215.77	71
Physician Assistant	99	97	$168.48	7
Nurse Practitioner	27	26	$159.01	2
Internal Medicine	14	14	$199.35	1
Sports Medicine	13	11	$231.32	1
Family Practice	11	11	$221.84	1
Hand Surgery	11	11	$252.25	1

28470 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	532	$210.00	$159.37	29
Pennsylvania	420	$213.25	$158.86	18
New York	326	$245.07	$162.34	16
New Jersey	268	$226.80	$162.64	14
South Carolina	167	$196.85	$155.40	7
Illinois	129	$213.48	$157.70	10
Massachusetts	105	$225.19	$149.18	6
California	102	$218.66	$146.83	6
Ohio	97	$197.39	$150.26	6
Virginia	87	$190.94	$146.59	5
Missouri	63	$188.10	$155.35	4
Alabama	63	$172.94	$141.10	3
Arizona	59	$217.21	$170.55	4
Iowa	56	$193.60	$165.43	4
Maryland	54	$239.73	$160.19	3
Mississippi	48	$171.24	$157.18	2
Indiana	42	$200.90	$171.46	3
Connecticut	40	$226.07	$172.75	3
Georgia	37	$199.54	$145.10	3
Kentucky	31	$191.71	$148.58	2
Michigan	31	$207.99	$168.06	2
Louisiana	29	$186.18	$171.76	1
Rhode Island	28	$217.69	$160.80	1
Minnesota	24	$208.55	$141.07	2
New Hampshire	17	$183.80	$124.80	1
Kansas	16	$197.65	$150.43	1
Delaware	13	$220.70	$176.68	1
West Virginia	13	$153.70	$114.46	1
North Carolina	13	$197.88	$155.85	1
Tennessee	12	$201.84	$142.92	1
New Mexico	12	$191.17	$161.96	1

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.