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

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 Puerto Rico, Medicare pays $360.13 for 28054 in the office and $223.37 when it’s performed in a hospital or facility.

$360.13Office (non-facility)
$223.37Hospital or facility
+0.7%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 Puerto Rico
  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 Puerto Rico 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. Puerto Rico pays $360.13. The RVUs are the same everywhere; the geographic indexes change the dollars.

28054 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$360.13
  2. Los Angeles, CA · California$401.65+$41.52
  3. Washington, DC area · District of Columbia$406.36+$46.23
  4. Miami, FL · Florida$382.04+$21.91
  5. Chicago, IL · Illinois$372.24+$12.11
  6. Manhattan, NY · New York$408.39+$48.26
  7. Alaska · Alaska$426.56+$66.43

Other areas in Puerto Rico first, then benchmark localities. Bars start at $0.

Every other payment area

28054 in every other Medicare payment locality
Payment localityOfficeFacility
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
El Centro, CACalifornia$377.51$229.25
Fresno, CACalifornia$377.46$229.20
Hanford, 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 Puerto Rico 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

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 28054 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work3.48× 1.0003.4800
Practice expense6.94× 1.0117.0163
Malpractice0.29× 0.9850.2856
Total RVUs10.7820
Conversion factor× 33.4009

Office rate, Puerto Rico$360.13

Office: (3.48 × 1 + 6.94 × 1.011 + 0.29 × 0.985) × $33.4009 = $360.13

Facility: (3.48 × 1 + 2.89 × 1.011 + 0.29 × 0.985) × $33.4009 = $223.37

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, Puerto Rico
Same family
28050Joint biopsy, foot joint liningFoot-joint lining biopsy code; distinguish it from this toe-joint biopsy by the sampled joint.$409.74
28052Joint biopsy, metatarsophalangeal jointAnother foot-joint lining biopsy code; use the applicable full descriptor for the sampled site.$383.54
Used instead
28072Joint synovectomy, foot metatarsophalangeal jointToe-joint lining removal is therapeutic; this code represents diagnostic tissue sampling.$505.71

How 28054 has changed in Puerto Rico

28054 · Office / nonfacility

$360.13

Effective 2026-10-01

The base rate is $4.82 higher than on 2025-10-01, moving from $355.31 to $360.13 (1.4%).

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

    $355.31changed to$360.13

    • 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
    • Practice expense GPCI 1.007 changed to 1.011
    • Malpractice GPCI 0.982 changed to 0.985

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $367.33changed to$355.31

    • 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

    $361.34changed to$367.33

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $370.11changed to$361.34

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 7.03 changed to 7.15
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $368.35changed to$370.11

    • Practice expense GPCI 1.000 changed to 1.008
    • Malpractice GPCI 1.000 changed to 0.984

  6. January 1, 2023

    RVU23A

    $376.58changed to$368.35

    • 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
    • Practice expense GPCI 1.008 changed to 1.000
    • Malpractice GPCI 0.986 changed to 1.000

    Held through RVU23B, RVU23C.

  7. January 1, 2022

    RVU22A

    $384.99changed to$376.58

    • 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.

  8. January 1, 2021

    RVU21A

    $390.20changed to$384.99

    • 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
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $392.34changed to$390.20

    • 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
    • Practice expense GPCI 1.007 changed to 1.008
    • Malpractice GPCI 0.990 changed to 0.988

    Held through RVU20B, RVU20C, RVU20D.

  10. January 1, 2019

    RVU19A

    $392.28changed to$392.34

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

    Held through RVU19B, RVU19C, RVU19D.

  11. January 1, 2018

    RVU18AR1

    $357.68changed to$392.28

    • 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
    • Practice expense GPCI 0.856 changed to 1.007
    • Malpractice GPCI 0.642 changed to 0.990

    Held through RVU18B, RVU18C, RVU18D.

  12. January 1, 2017

    RVU17A

    $318.66changed to$357.68

    • 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 0.705 changed to 0.856
    • Malpractice GPCI 0.293 changed to 0.642

    Held through RVU17B, RVU17C, RVU17D.

  13. January 1, 2016

    RVU16A

    $308.46changed to$318.66

    • 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.

  14. July 1, 2015

    RVU15C

    $306.92changed to$308.46

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $301.71changed to$306.92

    • 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
    • Practice expense GPCI 0.692 changed to 0.705
    • Malpractice GPCI 0.271 changed to 0.293

    Held through RVU15B.

  16. January 1, 2014

    RVU14A

    $298.60changed to$301.71

    • 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
    • Practice expense GPCI 0.678 changed to 0.692
    • Malpractice GPCI 0.249 changed to 0.271

    Held through RVU14B, RVU14C, RVU14D.

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: $298.60

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$360.13$223.37RVU26D
2026-07-01$360.13$223.37RVU26C
2026-04-01$360.13$223.37RVU26B
2026-01-01$360.13$223.37RVU26A
2025-10-01$355.31$232.51RVU25D
2025-07-01$355.31$232.51RVU25C
2025-04-01$355.31$232.51RVU25B
2025-01-01$355.31$232.51RVU25A
2024-10-01$367.33$236.60RVU24D
2024-07-01$367.33$236.60RVU24C
2024-04-01$367.33$236.60RVU24B
2024-03-09$367.33$236.60RVU24AR
2024-01-01$361.34$232.74RVU24A
2023-10-01$370.11$236.21RVU23D
2023-07-01$368.35$235.52RVU23C
2023-04-01$368.35$235.52RVU23B
2023-01-01$368.35$235.52RVU23A
2022-10-01$376.58$237.75RVU22D
2022-07-01$376.58$237.75RVU22C
2022-04-01$376.58$237.75RVU22B
2022-01-01$376.58$237.75RVU22A
2021-10-01$384.99$237.97RVU21D
2021-07-01$384.99$237.97RVU21C
2021-04-01$384.99$237.97RVU21B
2021-01-01$384.99$237.97RVU21A
2020-10-01$390.20$244.32RVU20D
2020-07-01$390.20$244.32RVU20C
2020-04-01$390.20$244.32RVU20B
2020-01-01$390.20$244.32RVU20A
2019-10-01$392.34$244.64RVU19D
2019-07-01$392.34$244.64RVU19C
2019-04-01$392.34$244.64RVU19B
2019-01-01$392.34$244.64RVU19A
2018-10-01$392.28$244.37RVU18D
2018-07-01$392.28$244.37RVU18C
2018-04-01$392.28$244.37RVU18B
2018-01-01$392.28$244.37RVU18AR1
2017-10-01$357.68$228.96RVU17D
2017-07-01$357.68$228.96RVU17C
2017-04-01$357.68$228.96RVU17B
2017-01-01$357.68$228.96RVU17A
2016-10-01$318.66$210.88RVU16D
2016-07-01$318.66$210.88RVU16C
2016-04-01$318.66$210.88RVU16B
2016-01-01$318.66$210.88RVU16A
2015-10-01$308.46$205.86RVU15D
2015-07-01$308.46$205.86RVU15C
2015-04-01$306.92$204.83RVU15B
2015-01-01$306.92$204.83RVU15A
2014-10-01$301.71$202.80RVU14D
2014-07-01$301.71$202.80RVU14C
2014-04-01$301.71$202.80RVU14B
2014-01-01$301.71$202.80RVU14A
2013-10-01$298.60$196.87RVU13D
2013-07-01$298.60$196.87RVU13C
2013-04-01$298.60$196.87RVU13B
2013-01-01$298.60$196.87RVU13AR

Price 28054 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

  • Aceitunas
  • Adjuntas
  • Aguada
  • Aguadilla
  • Aguas Buenas
  • Aguas Claras
  • Aguilita
  • Aibonito

Browse all communities in Puerto Rico

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 Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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