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

Reports surgical sampling of synovial lining from a toe joint when tissue is needed to investigate a joint condition.

CMS RVU26DEffective Oct 1, 2026One payment locality34 Medicare services in 2024

In Queens, NY, Medicare pays $411.63 for 28054 in the office and $251.74 when it’s performed in a hospital or facility.

$411.63Office (non-facility)
$251.74Hospital or facility
+15.1%vs the national office rate ($357.72)

Check a contract rate as a % of Medicare · 28054 nationwide

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

We’ll open 28054 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Queens, NY
  2. What 28054 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

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.

How Queens, NY compares for 28054

Across 109 of 109 payment localities, the office rate for 28054 runs from $320.34 in Arkansas to $468.47 in San Benito County, CA. Queens, NY pays $411.63. The RVUs are the same everywhere; the geographic indexes change the dollars.

28054 in Queens, NY vs other payment areas
  1. Queens, NY · this page$411.63
  2. Manhattan, NY · New York$408.39−$3.24
  3. NYC suburbs and Long Island, NY · New York$417.27+$5.64
  4. Poughkeepsie and northern NYC suburbs, NY · New York$387.01−$24.62
  5. Rest of New York · New York$343.26−$68.37
  6. Los Angeles, CA · California$401.65−$9.98
  7. Washington, DC area · District of Columbia$406.36−$5.27

Other areas in New York first, then benchmark localities. Bars start at $0.

Every other payment area

28054 in every other Medicare payment locality
Payment localityOfficeFacility
Miami, FLFlorida$382.04$241.22
Chicago, ILIllinois$372.24$236.29
AlaskaAlaska$426.56$282.49
AlabamaAlabama$324.54$206.18
ArkansasArkansas$320.34$204.14
ArizonaArizona$349.14$218.06
Bakersfield, CACalifornia$378.40$230.14
Chico, CACalifornia$377.46$229.20

28054 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$320.34

$426.56

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
28054 office rate range by state
State / territoryOffice rate rangeLocalities
AK$426.561
AL$324.541
AR$320.341
AZ$349.141
CA$377.46–$468.4729
CO$371.831
CT$379.931
DC$406.361
DE$354.541
FL$352.40–$382.043
GA$334.55–$363.732
GU$385.401
HI$385.401
IA$332.181
ID$334.071
IL$343.01–$372.274
IN$335.821
KS$330.671
KY$331.171
LA$330.66–$345.362
MA$369.90–$406.392
MD$360.87–$406.363
ME$335.52–$352.062
MI$338.81–$356.262
MN$357.631
MO$325.48–$346.623
MS$322.981
MT$357.701
NC$338.701
ND$351.971
NE$333.851
NH$366.021
NJ$384.64–$402.792
NM$340.431
NV$356.341
NY$343.26–$417.275
OH$337.631
OK$330.761
OR$353.92–$382.832
PA$338.18–$371.192
PR$360.131
RI$366.541
SC$338.651
SD$351.291
TN$332.141
TX$336.17–$370.308
UT$342.831
VA$350.94–$406.362
VI$360.131
VT$350.621
WA$369.21–$414.382
WI$341.291
WV$331.531
WY$355.211

See 28054 in every payment locality

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.

How the rate is built · 28054

RVUs × geographic indexes × conversion factor

Office or facility?

Work3.48

3.48 RVUs× 1.000 GPCI

Practice expense6.94

6.94 RVUs× 1.000 GPCI

Malpractice0.29

0.29 RVUs× 1.000 GPCI

Adjusted RVUs

10.7100

Conversion factor

$33.4009

Medicare rate

$357.72

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Queens, NY inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

3,106

Code
28054
Physician work
3.48
Practice expense
6.94
Malpractice
0.29

GPCI2026.csv

81

Locality
Queens, NY
Physician work
1.064
Practice expense
1.182
Malpractice
1.442
Office calculation for 28054 in Queens, NY
ComponentRVULocality factorAdjusted
Physician work3.48× 1.0643.7027
Practice expense6.94× 1.1828.2031
Malpractice0.29× 1.4420.4182
Total RVUs12.3240
Conversion factor× 33.4009

Office rate, Queens, NY$411.63

Office: (3.48 × 1.064 + 6.94 × 1.182 + 0.29 × 1.442) × $33.4009 = $411.63

Facility: (3.48 × 1.064 + 2.89 × 1.182 + 0.29 × 1.442) × $33.4009 = $251.74

Open 28054 in the RVU calculator

Payment rules and modifiers for 28054

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

CMS payment indicators · 28054

Joint biopsy, toe joint lining

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
Assistant at surgery (80/81/82/AS)0Not paid without supporting documentation.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.69/0.21Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 28054

Joint biopsy, toe joint lining

90-day global period ends

Dec 30, 2026

Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).

Visit on Oct 31, 2026

Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 50 · payment effect

With and without the modifier

28054 without 50 · national office

$357.72

Joint biopsy, toe joint lining

28054-50 · Bilateral: 150%

$536.58

Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).

When to use modifier 50

Codes related to 28054

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

Codes related to 28054
CodeHow it relatesOffice range, Queens, NY
Same family
28050Joint biopsy, foot joint liningFoot-joint lining biopsy code; distinguish it from this toe-joint biopsy by the sampled joint.$467.60
28052Joint biopsy, metatarsophalangeal jointAnother foot-joint lining biopsy code; use the applicable full descriptor for the sampled site.$437.90
Used instead
28072Joint synovectomy, foot metatarsophalangeal jointToe-joint lining removal is therapeutic; this code represents diagnostic tissue sampling.$580.42

How 28054 has changed in Queens, NY

28054 · Office / nonfacility

$411.63

Effective 2026-10-01

The base rate is $1.35 higher than on 2025-10-01, moving from $410.28 to $411.63 (0.3%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $410.28changed to$411.63

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 3.57 changed to 3.48
    • Practice expense RVU 7.09 changed to 6.94
    • Malpractice RVU 0.28 changed to 0.29
    • Work GPCI 1.065 changed to 1.064
    • Practice expense GPCI 1.195 changed to 1.182
    • Malpractice GPCI 1.462 changed to 1.442

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $424.12changed to$410.28

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 7.15 changed to 7.09
    • Malpractice RVU 0.27 changed to 0.28

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $417.20changed to$424.12

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $435.95changed to$417.20

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 7.03 changed to 7.15
    • Work GPCI 1.061 changed to 1.065
    • Practice expense GPCI 1.212 changed to 1.195
    • Malpractice GPCI 2.061 changed to 1.462

  5. January 1, 2023

    RVU23A

    $452.87changed to$435.95

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 6.98 changed to 7.03
    • Malpractice RVU 0.28 changed to 0.27
    • Work GPCI 1.056 changed to 1.061
    • Practice expense GPCI 1.228 changed to 1.212
    • Malpractice GPCI 2.661 changed to 2.061

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $462.55changed to$452.87

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 7.14 changed to 6.98
    • Malpractice RVU 0.27 changed to 0.28

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $462.70changed to$462.55

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 6.91 changed to 7.14
    • Malpractice RVU 0.28 changed to 0.27
    • Work GPCI 1.054 changed to 1.056
    • Practice expense GPCI 1.214 changed to 1.228
    • Malpractice GPCI 2.391 changed to 2.661

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $458.05changed to$462.70

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 7.02 changed to 6.91
    • Malpractice RVU 0.25 changed to 0.28
    • Work GPCI 1.052 changed to 1.054
    • Practice expense GPCI 1.200 changed to 1.214
    • Malpractice GPCI 2.121 changed to 2.391

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $457.98changed to$458.05

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 7.03 changed to 7.02

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $468.72changed to$457.98

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 7.27 changed to 7.03
    • Malpractice RVU 0.27 changed to 0.25
    • Malpractice GPCI 2.151 changed to 2.121

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $476.51changed to$468.72

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 7.44 changed to 7.27
    • Malpractice RVU 0.29 changed to 0.27
    • Practice expense GPCI 1.199 changed to 1.200
    • Malpractice GPCI 2.181 changed to 2.151

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $457.70changed to$476.51

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 7.00 changed to 7.44
    • Malpractice RVU 0.27 changed to 0.29

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $455.43changed to$457.70

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $448.58changed to$455.43

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 6.91 changed to 7.00
    • Malpractice RVU 0.26 changed to 0.27
    • Work GPCI 1.057 changed to 1.052
    • Practice expense GPCI 1.197 changed to 1.199
    • Malpractice GPCI 1.836 changed to 2.181

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $450.87changed to$448.58

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 7.58 changed to 6.91
    • Malpractice RVU 0.27 changed to 0.26
    • Work GPCI 1.062 changed to 1.057
    • Practice expense GPCI 1.195 changed to 1.197
    • Malpractice GPCI 1.491 changed to 1.836

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $450.87

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$411.63$251.74RVU26D
2026-07-01$411.63$251.74RVU26C
2026-04-01$411.63$251.74RVU26B
2026-01-01$411.63$251.74RVU26A
2025-10-01$410.28$264.56RVU25D
2025-07-01$410.28$264.56RVU25C
2025-04-01$410.28$264.56RVU25B
2025-01-01$410.28$264.56RVU25A
2024-10-01$424.12$268.98RVU24D
2024-07-01$424.12$268.98RVU24C
2024-04-01$424.12$268.98RVU24B
2024-03-09$424.12$268.98RVU24AR
2024-01-01$417.20$264.59RVU24A
2023-10-01$435.95$274.95RVU23D
2023-07-01$435.95$274.95RVU23C
2023-04-01$435.95$274.95RVU23B
2023-01-01$435.95$274.95RVU23A
2022-10-01$452.87$283.74RVU22D
2022-07-01$452.87$283.74RVU22C
2022-04-01$452.87$283.74RVU22B
2022-01-01$452.87$283.74RVU22A
2021-10-01$462.55$283.45RVU21D
2021-07-01$462.55$283.45RVU21C
2021-04-01$462.55$283.45RVU21B
2021-01-01$462.55$283.45RVU21A
2020-10-01$462.70$287.02RVU20D
2020-07-01$462.70$287.02RVU20C
2020-04-01$462.70$287.02RVU20B
2020-01-01$462.70$287.02RVU20A
2019-10-01$458.05$282.04RVU19D
2019-07-01$458.05$282.04RVU19C
2019-04-01$458.05$282.04RVU19B
2019-01-01$458.05$282.04RVU19A
2018-10-01$457.98$281.73RVU18D
2018-07-01$457.98$281.73RVU18C
2018-04-01$457.98$281.73RVU18B
2018-01-01$457.98$281.73RVU18AR1
2017-10-01$468.72$288.27RVU17D
2017-07-01$468.72$288.27RVU17C
2017-04-01$468.72$288.27RVU17B
2017-01-01$468.72$288.27RVU17A
2016-10-01$476.51$293.20RVU16D
2016-07-01$476.51$293.20RVU16C
2016-04-01$476.51$293.20RVU16B
2016-01-01$476.51$293.20RVU16A
2015-10-01$457.70$283.21RVU15D
2015-07-01$457.70$283.21RVU15C
2015-04-01$455.43$281.80RVU15B
2015-01-01$455.43$281.80RVU15A
2014-10-01$448.58$277.49RVU14D
2014-07-01$448.58$277.49RVU14C
2014-04-01$448.58$277.49RVU14B
2014-01-01$448.58$277.49RVU14A
2013-10-01$450.87$271.57RVU13D
2013-07-01$450.87$271.57RVU13C
2013-04-01$450.87$271.57RVU13B
2013-01-01$450.87$271.57RVU13AR

Price 28054 for an earlier date of service

Where the Queens, NY rate applies

Queens, NY is a Medicare payment area, not a city. Our Census mapping connects it to 1 cities and communities in New York. Some span more than one payment area; confirm with the service ZIP.

Browse all communities in New York

28054 billing questions

How is this different from a foot-joint lining biopsy?

This code is for tissue sampled from a toe joint. Codes 28050 and 28052 describe foot-joint lining biopsies; select according to the joint and the applicable full code descriptor.

When would a toe-joint exploration code be used instead?

Code 28024 describes exploration of a toe joint. Report 28054 when synovial lining tissue is sampled for diagnostic evaluation, rather than reporting exploration alone.

How does biopsy differ from removal of toe-joint lining?

A biopsy takes tissue for diagnosis. Code 28072 is associated with removal of toe-joint lining as a therapeutic procedure.

What documentation supports reporting this code?

The operative note should identify the toe joint, describe obtaining synovial lining tissue, and state the diagnostic reason for the sample.

How is bilateral performance reported?

CMS treats this as a bilateral procedure: modifier 50 is paid at 150% when the procedure is performed bilaterally.

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

Show the CMS file lines behind this rate
RVUs for 28054PPRRVU2026_Oct_nonQPP.csv, line 3,106 (RVU26D)
Geographic factors for Queens, NYGPCI2026.csv, line 81 (RVU26D)

Open CMS sourceHow we calculate rates

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