How much does Medicare pay for CPT 28750?

Medicare allowed an average of $1913.38 per service and paid $1519.45 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $7542.72, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 28750?

Fusion of big toe at joint with foot. It was billed 5,139 times to 4,999 Medicare beneficiaries by 314 providers in 2024.

Does 28750 pay differently in an office than a hospital?

Yes. The allowed amount averaged $538.81 in an office setting and $1931.53 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 28750 most?

Ambulatory Surgical Center, with 1,966 services from 114 clinicians. Next are Orthopedic Surgery, Podiatry, Physician Assistant.

CPT 28750

Fusion of big toe at joint with foot

$1913.38Medicare-allowed amount per service, averaged across 5,139 services

Providers submitted

$7542.72

Asking price, not received

Medicare allowed

$1913.38

The fee schedule figure

Medicare paid

$1519.45

Balance is patient coinsurance

Providers submitted an average of $7542.72 for this code and Medicare allowed $1913.38 — 3.9× 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 $1519.45 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $538.81
Hospital / facility: $1931.53

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 67 services were billed in an office setting and 5,072 in a facility.

Services: 5,139
Beneficiaries: 4,999
Providers billing it: 314
Total allowed: $9,832,860

What Medicare pays for CPT 28750

Across 5,139 services billed by 314 providers to 4,999 beneficiaries, Medicare allowed an average of $1913.38 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 28750

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ambulatory Surgical Center	1,966	1,913	$4200.64	114
Orthopedic Surgery	1,775	1,719	$522.72	107
Podiatry	1,285	1,258	$496.25	85
Physician Assistant	87	84	$81.38	6
Nurse Practitioner	26	25	$69.26	2

28750 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
Virginia	388	$1665.06	$1414.98	19
California	354	$2134.50	$1385.04	21
North Carolina	334	$2210.25	$1880.08	17
Florida	314	$1118.68	$920.88	22
Texas	313	$1683.74	$1415.97	20
Tennessee	216	$2514.35	$2255.93	13
Iowa	207	$2374.58	$2028.58	13
Arizona	206	$1714.13	$1391.81	12
Illinois	205	$2062.84	$1661.80	14
Pennsylvania	199	$1788.75	$1481.13	14
Maryland	161	$2765.79	$2215.37	11
Georgia	151	$2273.47	$1936.40	10
South Carolina	135	$1641.12	$1423.38	7
Ohio	130	$2642.45	$2175.94	8
Mississippi	125	$1489.14	$1387.82	7
Minnesota	118	$2012.41	$1598.92	7
Missouri	114	$1987.16	$1764.48	8
Indiana	112	$2272.39	$1882.05	8
Massachusetts	112	$1860.09	$1385.45	5
Arkansas	107	$1859.01	$1610.27	5
Montana	106	$2331.64	$1943.67	7
Washington	100	$2217.22	$1674.16	6
Kansas	97	$1824.75	$1546.06	7
North Dakota	94	$1310.17	$1149.65	6
Kentucky	85	$912.15	$816.39	6
South Dakota	81	$453.29	$368.86	6
Colorado	75	$1706.24	$1351.20	5
New York	63	$1073.68	$836.32	4
Michigan	55	$3424.99	$2774.08	4
Oregon	52	$4099.92	$3181.75	3
New Jersey	52	$1592.82	$1250.41	3
Nevada	42	$2521.29	$2066.02	2
Delaware	39	$2759.08	$2280.59	2
Nebraska	36	$345.95	$292.45	3
New Hampshire	30	$489.67	$385.57	2
Oklahoma	30	$508.92	$421.13	1
Wisconsin	28	$297.42	$235.81	2
Connecticut	22	$73.67	$60.32	1
Louisiana	21	$4434.63	$3718.08	1
Rhode Island	17	$581.10	$439.52	1
Alabama	13	$3875.38	$3789.59	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.