How Much Does Optx Metatarsal Fracture each Cost?
Also known as: Optx metatarsal fx each (CPT 28485)
Treatment of a Lisfranc (midfoot) fracture-dislocation with fixation.
Optx Metatarsal Fracture each (CPT 28485) costs $542 at Medicare rates. Hospital outpatient rate: $7.
Cost Comparison by Payer
How much Optx metatarsal fx each costs across different settings and payers
Patient Guide: Optx Metatarsal Fracture each
What you need to know before your appointment
What to Expect
Under anesthesia, the surgeon realigns the midfoot bones and secures them with screws or a plate. Hardware may be removed later.
How Long Does It Take?
1-2 hours
Common Reasons Doctors Order This
Lisfranc injury from twisting fall or crush injury, midfoot fracture-dislocation
How to Prepare
Fast before surgery. Non-weight-bearing for 6-8 weeks. Custom orthotics may be needed long-term.
Procedures Commonly Done Together
These procedures are frequently performed alongside Optx metatarsal fx each
How to Reduce Your Cost for Optx metatarsal fx each
Practical tips that can save you hundreds or thousands of dollars
- 1 Ask about cash-pay discounts
Many hospitals and clinics offer 20-40% discounts for self-pay patients. Always ask before scheduling.
- 2 Compare facility vs. office setting costs
Some procedures cost significantly less in an office setting than a hospital. Ask your provider about options.
- 3 Shop around — costs vary significantly
Costs can vary 2-3x between providers in the same city. Get quotes from multiple facilities.
- 4 Check ambulatory surgery centers (ASCs)
This procedure is available at ASCs for $4, compared to $7 at hospital outpatient departments. ASCs often offer lower costs with comparable quality.
How is the Price Calculated?
Medicare calculates procedure payments using Relative Value Units (RVUs). Each procedure has three components multiplied by a conversion factor ($33.40 in 2026) and adjusted by geographic cost indices.
Payment = Total RVU (16.23) x CF ($33.40) = $542
Related Procedures
Similar procedures in the same category or body system
Frequently Asked Questions
How much does Optx metatarsal fx each cost?
The Medicare facility rate for Optx metatarsal fx each is $542. In a hospital outpatient setting, the rate is $7. At an ambulatory surgery center, the rate is $4. Commercial insurance rates typically range from 150% to 250% of Medicare (varies by plan).
How much does Optx metatarsal fx each cost without insurance?
Without insurance, the cost of Optx metatarsal fx each can range from 150% of Medicare to 500% of Medicare depending on the facility. Many hospitals and clinics offer self-pay discounts of 20-40% off their chargemaster price. Always ask about cash pricing before your visit.
Does insurance cover Optx metatarsal fx each?
Most commercial health insurance plans and Medicare cover Optx metatarsal fx each when ordered by a physician for a medically necessary reason. Your out-of-pocket cost depends on your plan's deductible, copay/coinsurance structure, and whether you use an in-network provider. Check with your insurance company before scheduling to confirm coverage and get a cost estimate.
Why does the cost vary so much by location?
Medicare adjusts payments using Geographic Practice Cost Indices (GPCIs) that reflect local differences in physician work costs, practice expenses, and malpractice insurance. Manhattan, San Francisco, and other high-cost areas pay significantly more than rural regions. Commercial insurers follow similar geographic patterns.