CPT code 28054: Joint biopsy, toe joint lining2026 Medicare rate & RVUs

Medicare pays $357.72 for 28054 nationally in the office and $222.45 in a hospital or facility. Local office rates run $320.34–$468.47.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 28054 covers

A surgeon obtains a tissue sample from the synovial lining of a toe joint for diagnostic evaluation. This may be performed by a podiatric surgeon or an orthopedic foot and ankle surgeon in an operating room when a joint disorder requires tissue examination, such as suspected inflammatory or proliferative synovial disease. The specimen is submitted for examination; the service is sampling, not removal of the joint lining as treatment.

Report the code when the operative record identifies the toe joint sampled and documents that lining tissue was obtained for biopsy. It has a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple procedure reduction. For bilateral reporting, modifier 50 is paid at 150%. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 28054 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

28054 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 28054 rate is calculated

Each of 28054’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for 28054

28054 has a 90-day global period: related visits in that window are included in the surgery payment.

What modifiers do to the payment

When to use modifier 50

28054 compared with similar codes

How to choose

28050Joint biopsyFoot joint lining

This code concerns a foot-joint lining biopsy; 28054 is for a toe-joint lining biopsy. Base selection on the joint sampled and the full code descriptor.

28052Joint biopsyMetatarsophalangeal joint

Code 28052 is another foot-joint lining biopsy code. Code 28054 identifies biopsy of toe-joint lining.

28024Toe joint explorationInterphalangeal joint

Code 28024 describes exploration of a toe joint. Use 28054 when the operative service includes sampling the joint lining for diagnostic evaluation.

28072Joint synovectomyFoot metatarsophalangeal joint

Code 28072 concerns removal of toe-joint lining, whereas 28054 represents biopsy sampling rather than therapeutic removal.

Codes related to 28054

Related codes aren’t interchangeable: bill the code that matches the service performed.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates