CPT code 28126: Toe bone excision, complete phalanx removal2026 Medicare rate & RVUs in Aurora, Illinois

CPT 28126: $372.00–$404.65 office ($236.00–$251.66 facility) across 2 localities in Aurora, IL in 2026 Medicare. Compare each area.

CMS RVU26DEffective Oct 1, 20262 payment localities

Medicare pays $372.00–$404.65 for 28126 in the office in Aurora, Illinois, from Rest of Illinois to Suburban Chicago, IL. Which amount applies depends on the service address.

$372.00–$404.65Office (non-facility)

$236.00–$251.66Hospital or facility

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

On this page 6 sections

Rate in Aurora, Illinois
By payment locality
City and payment areas
How it’s calculated
Payment rules
Sources

Where 28126 pays more and less in Aurora, Illinois

Aurora, Illinois maps to 2 Medicare payment localities in our Census-to-CMS crosswalk. A city name alone doesn’t confirm an address’s payment area.

28126 office and facility rates by payment locality
Payment locality	Office	Facility
Rest of Illinois	$372.00	$236.00
Suburban Chicago, IL	$404.65	$251.66

How payment areas work in Aurora

City limits and Medicare payment areas are different maps. These are the payment areas that cover the city’s counties; the service ZIP decides which one applies.

Suburban Chicago · DuPage County, Kane County, Will County
Rest of Illinois · Kendall County

City boundaries: 2026 Census geography · Census source · CMS county-to-locality definitions

How the 28126 rate is calculated

Each of 28126’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 · 28126

RVUs × geographic indexes × conversion factor

Office or facility?

Your ZIP

Work3.55

3.55 RVUs× 1.000 GPCI

Practice expense7.66

7.66 RVUs× 1.000 GPCI

Malpractice0.38

0.38 RVUs× 1.000 GPCI

Adjusted RVUs

11.5900

Conversion factor

$33.4009

Medicare rate

$387.12

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

Payment rules and modifiers for 28126

28126 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 28126

Toe bone excision, complete phalanx removal

Rule	CMS value	What it means
Global period	090	Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures	2	Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)	0	The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)	1	Not paid (statutory restriction).
Co-surgeons (62)	0	Not permitted.
Team surgery (66)	0	Not permitted.
Professional/technical	0	Physician service: no professional/technical split.
Split (54/55/56)	0.10/0.69/0.21	Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 28126

Toe bone excision, complete phalanx removal

Date of surgery

Date of a later visit

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

28126 without 51 · national office

$387.12

Toe bone excision, complete phalanx removal

28126-51 · Second procedure: 50%

$193.56

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

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 28126PPRRVU2026_Oct_nonQPP.csv, line 3,135 (RVU26D)

3,13228120,,[CPT descriptor omitted],A,,7.13,12.47,,5.94,,0.96,20.56,14.03,0,090,0.10,0.69,0.21,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00

3,13328122,,[CPT descriptor omitted],A,,6.59,10.60,,5.13,,0.75,17.94,12.47,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00

3,13428124,,[CPT descriptor omitted],A,,4.88,8.85,,4.17,,0.47,14.20,9.52,0,090,0.10,0.69,0.21,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00

3,13528126,,[CPT descriptor omitted],A,,3.55,7.66,,3.20,,0.38,11.59,7.13,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00

3,13628130,,[CPT descriptor omitted],A,,9.26,7.28,NA,7.28,,1.39,17.93,17.93,0,090,0.10,0.69,0.21,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00

3,13728140,,[CPT descriptor omitted],A,,6.96,8.97,,4.01,,0.89,16.82,11.86,0,090,0.10,0.69,0.21,2,0,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00

3,13828150,,[CPT descriptor omitted],A,,4.12,7.85,,3.40,,0.43,12.40,7.95,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00

Open CMS source How we calculate rates

Fee sheets

Put 28126 and the rest of your codes on one sheet

Your codes at your locality, with payer contracts beside Medicare.

Build my fee sheet

Where 28126 pays more and less in Aurora, Illinois

How payment areas work in Aurora

How the 28126 rate is calculated

Payment rules and modifiers for 28126

What modifiers do to the payment

Where these rates come from

Did this answer your question about what 28126 pays in Aurora, Illinois?

Put 28126 and the rest of your codes on one sheet