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CPT code 28086: Tendon sheath excision, single sheath2026 Medicare rate & RVUs in Virginia

Surgical excision of diseased foot tendon sheath tissue, commonly for a sheath-associated ganglion, when the surgeon removes one tendon sheath.

CMS RVU26DEffective Oct 1, 2026One payment locality671 Medicare services in 2024

In Virginia, Medicare pays $527.95 for 28086 in the office and $326.68 when it’s performed in a hospital or facility.

$527.95Office (non-facility)
$326.68Hospital or facility
−2.3%vs the national office rate ($540.43)

Check a contract rate as a % of Medicare · 28086 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 28086 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Virginia
  2. What 28086 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 28086 covers

This procedure removes abnormal tissue from a tendon sheath in the foot, often when a ganglion arises from or involves the sheath. An orthopedic surgeon or podiatric surgeon typically performs the excision in an operating room or ambulatory surgery setting. The operative report should identify the tendon and foot location, describe the sheath tissue removed, and clarify whether the target was a sheath-associated lesion rather than a joint, nerve, or separate soft-tissue mass.

Report 28086 for the primary tendon sheath excision; 28088 is the add-on code for an additional sheath. The service has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and the others at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment may be made; co-surgeons require supporting documentation, and team surgery is 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 Virginia compares for 28086

Across 109 of 109 payment localities, the office rate for 28086 runs from $479.36 in Arkansas to $706.40 in San Benito County, CA. Virginia pays $527.95. The RVUs are the same everywhere; the geographic indexes change the dollars.

28086 in Virginia vs other payment areas
  1. Virginia · this page$527.95
  2. Los Angeles, CA · California$605.29+$77.34
  3. Washington, DC area · District of Columbia$615.33+$87.38
  4. Miami, FL · Florida$588.32+$60.37
  5. Chicago, IL · Illinois$571.46+$43.51
  6. Manhattan, NY · New York$621.47+$93.52
  7. Alaska · Alaska$634.14+$106.19

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

Every other payment area

28086 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$486.21$307.05
ArkansasArkansas$479.36$303.49
ArizonaArizona$526.19$327.79
Bakersfield, CACalifornia$569.39$344.99
Chico, CACalifornia$567.48$343.08
El Centro, CACalifornia$567.59$343.19
Fresno, CACalifornia$567.48$343.08
Hanford, CACalifornia$567.48$343.08

28086 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.

$479.36

$636.94

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

View every state and territory as a table
28086 office rate range by state
State / territoryOffice rate rangeLocalities
AK$634.141
AL$486.211
AR$479.361
AZ$526.191
CA$567.48–$706.4029
CO$560.531
CT$575.791
DC$615.331
DE$534.731
FL$535.58–$588.323
GA$505.89–$551.012
GU$580.391
HI$580.391
IA$496.871
ID$500.311
IL$521.47–$571.464
IN$503.101
KS$495.251
KY$498.801
LA$498.30–$522.232
MA$557.58–$614.142
MD$544.55–$615.333
ME$503.55–$529.192
MI$512.05–$542.782
MN$535.541
MO$490.40–$523.273
MS$484.941
MT$540.381
NC$508.581
ND$527.531
NE$499.331
NH$552.411
NJ$581.92–$609.352
NM$515.041
NV$537.161
NY$516.06–$637.035
OH$509.421
OK$497.241
OR$532.54–$577.222
PA$509.84–$562.202
PR$544.041
RI$552.951
SC$509.931
SD$526.011
TN$497.761
TX$506.63–$559.068
UT$516.711
VA$527.95–$615.332
VI$544.041
VT$526.121
WA$556.32–$625.822
WI$510.351
WV$502.831
WY$534.781

See 28086 in every payment locality

How the 28086 rate is calculated

Each of 28086’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 · 28086

RVUs × geographic indexes × conversion factor

Office or facility?

Work4.80

4.80 RVUs× 1.000 GPCI

Practice expense10.73

10.73 RVUs× 1.000 GPCI

Malpractice0.65

0.65 RVUs× 1.000 GPCI

Adjusted RVUs

16.1800

Conversion factor

$33.4009

Medicare rate

$540.43

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

The exact Virginia inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

3,113

Code
28086
Physician work
4.80
Practice expense
10.73
Malpractice
0.65

GPCI2026.csv

106

Locality
Virginia
Physician work
1.000
Practice expense
0.983
Malpractice
0.706
Office calculation for 28086 in Virginia
ComponentRVULocality factorAdjusted
Physician work4.80× 1.0004.8000
Practice expense10.73× 0.98310.5476
Malpractice0.65× 0.7060.4589
Total RVUs15.8065
Conversion factor× 33.4009

Office rate, Virginia$527.95

Office: (4.8 × 1 + 10.73 × 0.983 + 0.65 × 0.706) × $33.4009 = $527.95

Facility: (4.8 × 1 + 4.6 × 0.983 + 0.65 × 0.706) × $33.4009 = $326.68

Open 28086 in the RVU calculator

Payment rules and modifiers for 28086

28086 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 28086

Tendon sheath excision, single sheath

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)2Paid.
Co-surgeons (62)1Permitted with supporting documentation.
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 · 28086

Tendon sheath excision, single sheath

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

28086 without 50 · national office

$540.43

Tendon sheath excision, single sheath

28086-50 · Bilateral: 150%

$810.64

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 28086

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

Codes related to 28086
CodeHow it relatesOffice range, Virginia
Add-on codes
28088Tendon sheath surgery, extensor tendon sheathAdd-on for excision of an additional foot tendon sheath.$471.03
Used instead
28010Toe tendon release, single tendon, percutaneousReports incision of a toe tendon rather than excision of its sheath.$230.71
28011Toe tendon release, multiple tendonsReports incision of toe tendons rather than excision of a tendon sheath.$313.77
28039Tumor excision, subcutaneous, 1.5 cm or largerConsider for a qualifying subcutaneous foot or toe tumor, not a sheath excision.$466.07
28043Tumor excision, subcutaneous, under 1.5 cmFor a qualifying smaller subcutaneous foot or toe tumor rather than a sheath excision.$374.10

How 28086 has changed in Virginia

28086 · Office / nonfacility

$527.95

Effective 2026-10-01

The base rate is $35.45 higher than on 2025-10-01, moving from $492.50 to $527.95 (7.2%).

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

    $492.50changed to$527.95

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 4.92 changed to 4.80
    • Practice expense RVU 9.98 changed to 10.73
    • Malpractice RVU 0.63 changed to 0.65
    • Work GPCI 1.002 changed to 1.000
    • Practice expense GPCI 0.984 changed to 0.983
    • Malpractice GPCI 0.755 changed to 0.706

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $513.96changed to$492.50

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 10.19 changed to 9.98
    • Malpractice RVU 0.64 changed to 0.63

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $505.57changed to$513.96

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $530.13changed to$505.57

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 10.29 changed to 10.19
    • Malpractice RVU 0.65 changed to 0.64
    • Work GPCI 1.000 changed to 1.002
    • Practice expense GPCI 0.990 changed to 0.984
    • Malpractice GPCI 0.826 changed to 0.755

  5. January 1, 2023

    RVU23A

    $546.76changed to$530.13

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 10.33 changed to 10.29
    • Malpractice RVU 0.67 changed to 0.65
    • Practice expense GPCI 0.995 changed to 0.990
    • Malpractice GPCI 0.897 changed to 0.826

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $556.95changed to$546.76

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 10.52 changed to 10.33
    • Malpractice RVU 0.64 changed to 0.67

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $553.17changed to$556.95

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 9.91 changed to 10.52
    • Malpractice RVU 0.65 changed to 0.64
    • Practice expense GPCI 0.991 changed to 0.995
    • Malpractice GPCI 0.903 changed to 0.897

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $559.53changed to$553.17

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 10.13 changed to 9.91
    • Malpractice RVU 0.68 changed to 0.65
    • Practice expense GPCI 0.986 changed to 0.991
    • Malpractice GPCI 0.908 changed to 0.903

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $560.69changed to$559.53

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 10.18 changed to 10.13

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $556.51changed to$560.69

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 10.15 changed to 10.18
    • Practice expense GPCI 0.985 changed to 0.986
    • Malpractice GPCI 0.866 changed to 0.908

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $556.10changed to$556.51

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 10.20 changed to 10.15
    • Malpractice RVU 0.71 changed to 0.68
    • Practice expense GPCI 0.983 changed to 0.985
    • Malpractice GPCI 0.824 changed to 0.866

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $561.88changed to$556.10

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 10.29 changed to 10.20
    • Malpractice RVU 0.73 changed to 0.71

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $559.08changed to$561.88

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $547.24changed to$559.08

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 10.02 changed to 10.29
    • Malpractice RVU 0.69 changed to 0.73
    • Practice expense GPCI 0.980 changed to 0.983
    • Malpractice GPCI 0.778 changed to 0.824

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $553.94changed to$547.24

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 11.09 changed to 10.02
    • Malpractice RVU 0.72 changed to 0.69
    • Practice expense GPCI 0.977 changed to 0.980
    • Malpractice GPCI 0.731 changed to 0.778

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $553.94

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$527.95$326.68RVU26D
2026-07-01$527.95$326.68RVU26C
2026-04-01$527.95$326.68RVU26B
2026-01-01$527.95$326.68RVU26A
2025-10-01$492.50$336.22RVU25D
2025-07-01$492.50$336.22RVU25C
2025-04-01$492.50$336.22RVU25B
2025-01-01$492.50$336.22RVU25A
2024-10-01$513.96$345.93RVU24D
2024-07-01$513.96$345.93RVU24C
2024-04-01$513.96$345.93RVU24B
2024-03-09$513.96$345.93RVU24AR
2024-01-01$505.57$340.28RVU24A
2023-10-01$530.13$353.33RVU23D
2023-07-01$530.13$353.33RVU23C
2023-04-01$530.13$353.33RVU23B
2023-01-01$530.13$353.33RVU23A
2022-10-01$546.76$360.47RVU22D
2022-07-01$546.76$360.47RVU22C
2022-04-01$546.76$360.47RVU22B
2022-01-01$546.76$360.47RVU22A
2021-10-01$556.95$361.13RVU21D
2021-07-01$556.95$361.13RVU21C
2021-04-01$556.95$361.13RVU21B
2021-01-01$556.95$361.13RVU21A
2020-10-01$553.17$364.69RVU20D
2020-07-01$553.17$364.69RVU20C
2020-04-01$553.17$364.69RVU20B
2020-01-01$553.17$364.69RVU20A
2019-10-01$559.53$368.35RVU19D
2019-07-01$559.53$368.35RVU19C
2019-04-01$559.53$368.35RVU19B
2019-01-01$559.53$368.35RVU19A
2018-10-01$560.69$368.30RVU18D
2018-07-01$560.69$368.30RVU18C
2018-04-01$560.69$368.30RVU18B
2018-01-01$560.69$368.30RVU18AR1
2017-10-01$556.51$365.97RVU17D
2017-07-01$556.51$365.97RVU17C
2017-04-01$556.51$365.97RVU17B
2017-01-01$556.51$365.97RVU17A
2016-10-01$556.10$365.34RVU16D
2016-07-01$556.10$365.34RVU16C
2016-04-01$556.10$365.34RVU16B
2016-01-01$556.10$365.34RVU16A
2015-10-01$561.88$368.31RVU15D
2015-07-01$561.88$368.31RVU15C
2015-04-01$559.08$366.48RVU15B
2015-01-01$559.08$366.48RVU15A
2014-10-01$547.24$361.18RVU14D
2014-07-01$547.24$361.18RVU14C
2014-04-01$547.24$361.18RVU14B
2014-01-01$547.24$361.18RVU14A
2013-10-01$553.94$356.82RVU13D
2013-07-01$553.94$356.82RVU13C
2013-04-01$553.94$356.82RVU13B
2013-01-01$553.94$356.82RVU13AR

Price 28086 for an earlier date of service

Where the Virginia rate applies

Virginia is a Medicare payment area, not a city. Our Census mapping connects it to 628 cities and communities in Virginia. Some span more than one payment area; confirm with the service ZIP.

  • Abbs Valley
  • Abingdon
  • Accomac
  • Adwolf
  • Afton
  • Alberta
  • Aldie
  • Allison Gap

Browse all communities in Virginia

28086 billing questions

When is 28086 used instead of 28088?

Use 28086 for the primary tendon sheath excision. Use 28088 for each additional sheath excised in the same operative session.

Is a tendon sheath ganglion included in this procedure?

Yes, a ganglion arising from or involving a foot tendon sheath is a typical reason for excision. The operative note should establish the sheath relationship and tissue removed.

How does 28086 differ from tendon incision codes 28010 and 28011?

28086 reports excision of tendon sheath tissue. Codes 28010 and 28011 describe tendon incision or release, not removal of the sheath.

What documentation supports reporting 28086?

Document the foot and tendon location, the sheath or sheath-associated lesion excised, and the extent of removal. If another sheath is excised, identify it to support the additional-sheath code.

What global and multiple-procedure payment rules apply?

The code has a 90-day global period. When procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50%.

Can modifier 50 or an assistant-at-surgery service be reported?

Bilateral reporting with modifier 50 is paid at 150%, and assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation.

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 28086PPRRVU2026_Oct_nonQPP.csv, line 3,113 (RVU26D)
Geographic factors for VirginiaGPCI2026.csv, line 106 (RVU26D)

Open CMS sourceHow we calculate rates

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