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CPT code 28104: Bone lesion excision, tarsal or metatarsal, without graft2026 Medicare rate & RVUs in Puerto Rico

Reports excision or curettage of a bone cyst or benign tumor in a tarsal or metatarsal bone when the procedure does not include bone grafting.

CMS RVU26DEffective Oct 1, 2026One payment locality1.5K Medicare services in 2024

In Puerto Rico, Medicare pays $544.27 for 28104 in the office and $340.65 when it’s performed in a hospital or facility.

$544.27Office (non-facility)
$340.65Hospital or facility
+0.6%vs the national office rate ($540.76)

Check a contract rate as a % of Medicare · 28104 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 28104 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Puerto Rico
  2. What 28104 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 28104 covers

An orthopedic surgeon or podiatric surgeon uses this service to remove or curette a bone cyst or benign tumor from a tarsal or metatarsal bone. The operative site is bone, not a skin or soft-tissue lesion. The procedure may be performed in a hospital or ambulatory surgical setting; less commonly, it is performed in an office setting. The surgeon’s report should identify the affected bone and describe the lesion removal or curettage.

Report this code for the tarsal or metatarsal site when the procedure does not include bone grafting. If grafting is performed, select the code that describes the grafted procedure instead. Medicare assigns a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50%. Modifier 50 is inappropriate for this code. Assistant-at-surgery payment may be made; co-surgeon payment requires 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 Puerto Rico compares for 28104

Across 109 of 109 payment localities, the office rate for 28104 runs from $481.32 in Arkansas to $703.52 in San Benito County, CA. Puerto Rico pays $544.27. The RVUs are the same everywhere; the geographic indexes change the dollars.

28104 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$544.27
  2. Los Angeles, CA · California$604.29+$60.02
  3. Washington, DC area · District of Columbia$614.38+$70.11
  4. Miami, FL · Florida$587.71+$43.44
  5. Chicago, IL · Illinois$571.38+$27.11
  6. Manhattan, NY · New York$620.64+$76.37
  7. Alaska · Alaska$639.46+$95.19

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

Every other payment area

28104 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$487.98$311.75
ArkansasArkansas$481.32$308.31
ArizonaArizona$526.89$331.73
Bakersfield, CACalifornia$569.07$348.33
Chico, CACalifornia$567.17$346.42
El Centro, CACalifornia$567.27$346.53
Fresno, CACalifornia$567.17$346.42
Hanford, CACalifornia$567.17$346.42

28104 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.

$481.32

$639.46

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

View every state and territory as a table
28104 office rate range by state
State / territoryOffice rate rangeLocalities
AK$639.461
AL$487.981
AR$481.321
AZ$526.891
CA$567.17–$703.5229
CO$560.411
CT$575.481
DC$614.381
DE$535.281
FL$536.20–$587.713
GA$507.28–$551.142
GU$579.441
HI$579.441
IA$498.291
ID$501.651
IL$522.52–$571.384
IN$504.371
KS$496.751
KY$500.311
LA$499.84–$523.132
MA$557.61–$612.952
MD$544.90–$614.383
ME$504.84–$529.742
MI$513.24–$543.242
MN$535.801
MO$492.18–$524.103
MS$486.801
MT$540.721
NC$509.731
ND$528.061
NE$500.671
NH$552.361
NJ$581.71–$608.692
NM$516.171
NV$537.541
NY$517.01–$635.835
OH$510.651
OK$498.751
OR$533.02–$576.662
PA$511.05–$562.242
PR$544.271
RI$553.191
SC$511.101
SD$526.571
TN$499.191
TX$507.92–$558.858
UT$517.701
VA$528.56–$614.382
VI$544.271
VT$526.721
WA$556.33–$624.422
WI$511.351
WV$504.381
WY$535.201

See 28104 in every payment locality

How the 28104 rate is calculated

Each of 28104’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 · 28104

RVUs × geographic indexes × conversion factor

Office or facility?

Work5.13

5.13 RVUs× 1.000 GPCI

Practice expense10.42

10.42 RVUs× 1.000 GPCI

Malpractice0.64

0.64 RVUs× 1.000 GPCI

Adjusted RVUs

16.1900

Conversion factor

$33.4009

Medicare rate

$540.76

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

3,120

Code
28104
Physician work
5.13
Practice expense
10.42
Malpractice
0.64

GPCI2026.csv

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 28104 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work5.13× 1.0005.1300
Practice expense10.42× 1.01110.5346
Malpractice0.64× 0.9850.6304
Total RVUs16.2950
Conversion factor× 33.4009

Office rate, Puerto Rico$544.27

Office: (5.13 × 1 + 10.42 × 1.011 + 0.64 × 0.985) × $33.4009 = $544.27

Facility: (5.13 × 1 + 4.39 × 1.011 + 0.64 × 0.985) × $33.4009 = $340.65

Open 28104 in the RVU calculator

Payment rules and modifiers for 28104

28104 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 28104

Bone lesion excision, tarsal or metatarsal, without graft

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)0The 150% bilateral adjustment doesn’t apply.
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 · 28104

Bone lesion excision, tarsal or metatarsal, without graft

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 51 · payment effect

With and without the modifier

28104 without 51 · national office

$540.76

Bone lesion excision, tarsal or metatarsal, without graft

28104-51 · Second procedure: 50%

$270.38

When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).

When to use modifier 51

Codes related to 28104

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

Codes related to 28104
CodeHow it relatesOffice range, Puerto Rico
Used instead
28100Bone lesion excision, talus or calcaneusUsed for a bone cyst or benign tumor in the talus or calcaneus.$649.54
28108Toe bone lesion, phalanx of the footUsed for a bone cyst or benign tumor in a foot phalanx.$434.04
Same family
28106Foot bone lesion, tarsal or metatarsal, autograftGraft-inclusive option for a tarsal or metatarsal lesion procedure.No office rate
28107Bone lesion surgery, tarsal or metatarsal, allograftGraft-inclusive option for a tarsal or metatarsal lesion procedure.$500.69

How 28104 has changed in Puerto Rico

28104 · Office / nonfacility

$544.27

Effective 2026-10-01

The base rate is $30.02 higher than on 2025-10-01, moving from $514.25 to $544.27 (5.8%).

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

    $514.25changed to$544.27

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 5.26 changed to 5.13
    • Practice expense RVU 9.95 changed to 10.42
    • Malpractice RVU 0.63 changed to 0.64
    • 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

    $527.21changed to$514.25

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 9.90 changed to 9.95
    • Malpractice RVU 0.62 changed to 0.63

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $518.61changed to$527.21

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $530.62changed to$518.61

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 9.74 changed to 9.90
    • Malpractice RVU 0.59 changed to 0.62
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $528.30changed to$530.62

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

  6. January 1, 2023

    RVU23A

    $538.77changed to$528.30

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 9.64 changed to 9.74
    • Malpractice RVU 0.60 changed to 0.59
    • 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

    $550.62changed to$538.77

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 9.84 changed to 9.64
    • Malpractice RVU 0.61 changed to 0.60

    Held through RVU22B, RVU22C, RVU22D.

  8. January 1, 2021

    RVU21A

    $553.18changed to$550.62

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 9.40 changed to 9.84
    • Malpractice RVU 0.60 changed to 0.61
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $557.56changed to$553.18

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 9.56 changed to 9.40
    • Malpractice RVU 0.59 changed to 0.60
    • 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

    $552.97changed to$557.56

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 9.46 changed to 9.56
    • Malpractice RVU 0.58 changed to 0.59

    Held through RVU19B, RVU19C, RVU19D.

  11. January 1, 2018

    RVU18AR1

    $491.22changed to$552.97

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 9.41 changed to 9.46
    • 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

    $431.44changed to$491.22

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 9.39 changed to 9.41
    • 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

    $436.46changed to$431.44

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 9.51 changed to 9.39
    • Malpractice RVU 0.62 changed to 0.58

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $434.28changed to$436.46

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $422.03changed to$434.28

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 9.22 changed to 9.51
    • Malpractice RVU 0.52 changed to 0.62
    • 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

    $414.21changed to$422.03

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 10.00 changed to 9.22
    • Malpractice RVU 0.54 changed to 0.52
    • 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: $414.21

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$544.27$340.65RVU26D
2026-07-01$544.27$340.65RVU26C
2026-04-01$544.27$340.65RVU26B
2026-01-01$544.27$340.65RVU26A
2025-10-01$514.25$353.34RVU25D
2025-07-01$514.25$353.34RVU25C
2025-04-01$514.25$353.34RVU25B
2025-01-01$514.25$353.34RVU25A
2024-10-01$527.21$358.60RVU24D
2024-07-01$527.21$358.60RVU24C
2024-04-01$527.21$358.60RVU24B
2024-03-09$527.21$358.60RVU24AR
2024-01-01$518.61$352.75RVU24A
2023-10-01$530.62$358.12RVU23D
2023-07-01$528.30$357.17RVU23C
2023-04-01$528.30$357.17RVU23B
2023-01-01$528.30$357.17RVU23A
2022-10-01$538.77$360.17RVU22D
2022-07-01$538.77$360.17RVU22C
2022-04-01$538.77$360.17RVU22B
2022-01-01$538.77$360.17RVU22A
2021-10-01$550.62$362.80RVU21D
2021-07-01$550.62$362.80RVU21C
2021-04-01$550.62$362.80RVU21B
2021-01-01$550.62$362.80RVU21A
2020-10-01$553.18$369.11RVU20D
2020-07-01$553.18$369.11RVU20C
2020-04-01$553.18$369.11RVU20B
2020-01-01$553.18$369.11RVU20A
2019-10-01$557.56$371.02RVU19D
2019-07-01$557.56$371.02RVU19C
2019-04-01$557.56$371.02RVU19B
2019-01-01$557.56$371.02RVU19A
2018-10-01$552.97$367.72RVU18D
2018-07-01$552.97$367.72RVU18C
2018-04-01$552.97$367.72RVU18B
2018-01-01$552.97$367.72RVU18AR1
2017-10-01$491.22$335.47RVU17D
2017-07-01$491.22$335.47RVU17C
2017-04-01$491.22$335.47RVU17B
2017-01-01$491.22$335.47RVU17A
2016-10-01$431.44$303.46RVU16D
2016-07-01$431.44$303.46RVU16C
2016-04-01$431.44$303.46RVU16B
2016-01-01$431.44$303.46RVU16A
2015-10-01$436.46$306.24RVU15D
2015-07-01$436.46$306.24RVU15C
2015-04-01$434.28$304.72RVU15B
2015-01-01$434.28$304.72RVU15A
2014-10-01$422.03$299.08RVU14D
2014-07-01$422.03$299.08RVU14C
2014-04-01$422.03$299.08RVU14B
2014-01-01$422.03$299.08RVU14A
2013-10-01$414.21$288.49RVU13D
2013-07-01$414.21$288.49RVU13C
2013-04-01$414.21$288.49RVU13B
2013-01-01$414.21$288.49RVU13AR

Price 28104 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

28104 billing questions

Which bone lesions are reported with 28104?

Use it for excision or curettage of a bone cyst or benign tumor in a tarsal or metatarsal bone, without bone grafting. The operative note should identify the bone treated.

How does 28104 differ from 28106 or 28107?

28104 describes removal or curettage without grafting. Choose 28106 or 28107 when the procedure includes the graft type described by that code.

Can the surgeon separately report bone grafting with 28104?

When grafting is part of the lesion procedure, use the applicable graft-inclusive code rather than reporting 28104 and adding the graft procedure separately.

Should modifier 50 be used for lesions on both feet?

No. CMS identifies bilateral adjustment as inappropriate for this code. Modifier 50 should not be used.

What postoperative care is included?

The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.

Can an assistant or co-surgeon be paid?

Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team surgery is not permitted.

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 28104PPRRVU2026_Oct_nonQPP.csv, line 3,120 (RVU26D)
Geographic factors for Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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