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

Reports complete excision of a toe phalanx, such as for a bone problem requiring removal of the phalanx while preserving the toe.

CMS RVU26DEffective Oct 1, 2026One payment locality948 Medicare services in 2024

In North Carolina, Medicare pays $365.39 for 28126 in the office and $226.41 when it’s performed in a hospital or facility.

$365.39Office (non-facility)
$226.41Hospital or facility
−5.6%vs the national office rate ($387.12)

Check a contract rate as a % of Medicare · 28126 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 28126 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in North Carolina
  2. What 28126 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 28126 covers

This procedure removes an entire phalanx—the bone segment in a toe—while leaving the toe itself in place. A foot and ankle surgeon, podiatrist, or other qualified surgeon may perform it for conditions such as bone infection or a painful deformity when complete removal of that phalanx is part of the operative plan. The operative report should identify the toe and phalanx and make clear that the entire phalanx, rather than only part of it, was excised.

Report the code for complete phalanx excision; partial removal belongs to a different code. The 90-day global period includes the day-before preoperative visit and 90 days of 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 50% multiple-procedure reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery, and 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 North Carolina compares for 28126

Across 109 of 109 payment localities, the office rate for 28126 runs from $344.89 in Arkansas to $507.36 in San Benito County, CA. North Carolina pays $365.39. The RVUs are the same everywhere; the geographic indexes change the dollars.

28126 in North Carolina vs other payment areas
  1. North Carolina · this page$365.39
  2. Los Angeles, CA · California$434.53+$69.14
  3. Washington, DC area · District of Columbia$440.50+$75.11
  4. Miami, FL · Florida$417.01+$51.62
  5. Chicago, IL · Illinois$405.66+$40.27
  6. Manhattan, NY · New York$443.59+$78.20
  7. Alaska · Alaska$457.33+$91.94

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

Every other payment area

28126 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$349.63$219.28
ArkansasArkansas$344.89$216.92
ArizonaArizona$377.36$233.01
Bakersfield, CACalifornia$408.97$245.70
Chico, CACalifornia$407.80$244.54
El Centro, CACalifornia$407.87$244.60
Fresno, CACalifornia$407.80$244.54
Hanford, CACalifornia$407.80$244.54

28126 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.

$344.89

$457.58

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

View every state and territory as a table
28126 office rate range by state
State / territoryOffice rate rangeLocalities
AK$457.331
AL$349.631
AR$344.891
AZ$377.361
CA$407.80–$507.3629
CO$402.131
CT$411.851
DC$440.501
DE$383.361
FL$382.24–$417.013
GA$361.92–$394.122
GU$416.821
HI$416.821
IA$357.721
ID$359.961
IL$372.00–$405.664
IN$361.921
KS$356.261
KY$357.641
LA$357.16–$373.752
MA$400.00–$440.222
MD$390.33–$440.503
ME$361.85–$380.132
MI$366.49–$386.872
MN$385.601
MO$351.48–$374.863
MS$348.241
MT$387.091
NC$365.391
ND$379.581
NE$359.521
NH$396.021
NJ$416.63–$436.392
NM$368.431
NV$385.251
NY$370.55–$453.945
OH$364.961
OK$356.911
OR$382.32–$414.162
PA$365.44–$402.192
PR$389.741
RI$396.441
SC$365.771
SD$378.691
TN$357.961
TX$363.19–$400.758
UT$370.471
VA$379.04–$440.502
VI$389.741
VT$378.291
WA$399.18–$448.802
WI$367.591
WV$359.071
WY$383.821

See 28126 in every payment locality

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?

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.

The exact North Carolina inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

3,135

Code
28126
Physician work
3.55
Practice expense
7.66
Malpractice
0.38

GPCI2026.csv

83

Locality
North Carolina
Physician work
1.000
Practice expense
0.933
Malpractice
0.639
Office calculation for 28126 in North Carolina
ComponentRVULocality factorAdjusted
Physician work3.55× 1.0003.5500
Practice expense7.66× 0.9337.1468
Malpractice0.38× 0.6390.2428
Total RVUs10.9396
Conversion factor× 33.4009

Office rate, North Carolina$365.39

Office: (3.55 × 1 + 7.66 × 0.933 + 0.38 × 0.639) × $33.4009 = $365.39

Facility: (3.55 × 1 + 3.2 × 0.933 + 0.38 × 0.639) × $33.4009 = $226.41

Open 28126 in the RVU calculator

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

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)1Not paid (statutory restriction).
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 · 28126

Toe bone excision, complete phalanx removal

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

Codes related to 28126

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

Codes related to 28126
CodeHow it relatesOffice range, North Carolina
Same family
28124Toe bone excision, partial phalanx excisionPartial excision of a toe phalanx rather than complete excision.$448.82
Used instead
28150Toe amputation, at the MTP jointPhalangectomy of a toe; distinguish the documented procedure from complete excision of one phalanx.$391.42
28153Toe bone removal, partial excisionTargets resection of distal phalanx condyle(s), rather than complete phalanx excision.$376.54
28160Toe bone excision, joint or partial phalanxDescribes hemiphalangectomy or interphalangeal joint excision involving the proximal phalanx.$384.20

How 28126 has changed in North Carolina

28126 · Office / nonfacility

$365.39

Effective 2026-10-01

The base rate is $11.62 higher than on 2025-10-01, moving from $353.77 to $365.39 (3.3%).

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

    $353.77changed to$365.39

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 3.64 changed to 3.55
    • Practice expense RVU 7.60 changed to 7.66
    • Malpractice RVU 0.39 changed to 0.38
    • Practice expense GPCI 0.926 changed to 0.933
    • Malpractice GPCI 0.665 changed to 0.639

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $367.90changed to$353.77

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 7.71 changed to 7.60
    • Malpractice RVU 0.41 changed to 0.39

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $361.89changed to$367.90

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $371.08changed to$361.89

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 7.59 changed to 7.71
    • Malpractice RVU 0.37 changed to 0.41
    • Practice expense GPCI 0.927 changed to 0.926
    • Malpractice GPCI 0.742 changed to 0.665

  5. January 1, 2023

    RVU23A

    $376.99changed to$371.08

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 7.49 changed to 7.59
    • Practice expense GPCI 0.928 changed to 0.927
    • Malpractice GPCI 0.819 changed to 0.742

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $383.47changed to$376.99

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 7.62 changed to 7.49
    • Malpractice RVU 0.34 changed to 0.37

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $387.01changed to$383.47

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 7.34 changed to 7.62
    • Practice expense GPCI 0.930 changed to 0.928
    • Malpractice GPCI 0.757 changed to 0.819

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $389.83changed to$387.01

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 7.47 changed to 7.34
    • Malpractice RVU 0.32 changed to 0.34
    • Practice expense GPCI 0.931 changed to 0.930
    • Malpractice GPCI 0.695 changed to 0.757

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $390.41changed to$389.83

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 7.50 changed to 7.47

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $388.97changed to$390.41

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 7.48 changed to 7.50
    • Malpractice GPCI 0.732 changed to 0.695

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $387.86changed to$388.97

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 7.47 changed to 7.48
    • Practice expense GPCI 0.930 changed to 0.931
    • Malpractice GPCI 0.768 changed to 0.732

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $389.20changed to$387.86

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 7.46 changed to 7.47
    • Malpractice RVU 0.33 changed to 0.32

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $387.27changed to$389.20

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $385.32changed to$387.27

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 7.40 changed to 7.46
    • Practice expense GPCI 0.929 changed to 0.930
    • Malpractice GPCI 0.732 changed to 0.768

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $387.67changed to$385.32

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 8.11 changed to 7.40
    • Malpractice RVU 0.34 changed to 0.33
    • Practice expense GPCI 0.927 changed to 0.929
    • Malpractice GPCI 0.695 changed to 0.732

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $387.67

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$365.39$226.41RVU26D
2026-07-01$365.39$226.41RVU26C
2026-04-01$365.39$226.41RVU26B
2026-01-01$365.39$226.41RVU26A
2025-10-01$353.77$233.96RVU25D
2025-07-01$353.77$233.96RVU25C
2025-04-01$353.77$233.96RVU25B
2025-01-01$353.77$233.96RVU25A
2024-10-01$367.90$239.98RVU24D
2024-07-01$367.90$239.98RVU24C
2024-04-01$367.90$239.98RVU24B
2024-03-09$367.90$239.98RVU24AR
2024-01-01$361.89$236.06RVU24A
2023-10-01$371.08$239.46RVU23D
2023-07-01$371.08$239.46RVU23C
2023-04-01$371.08$239.46RVU23B
2023-01-01$371.08$239.46RVU23A
2022-10-01$376.99$241.15RVU22D
2022-07-01$376.99$241.15RVU22C
2022-04-01$376.99$241.15RVU22B
2022-01-01$376.99$241.15RVU22A
2021-10-01$383.47$240.35RVU21D
2021-07-01$383.47$240.35RVU21C
2021-04-01$383.47$240.35RVU21B
2021-01-01$383.47$240.35RVU21A
2020-10-01$387.01$245.71RVU20D
2020-07-01$387.01$245.71RVU20C
2020-04-01$387.01$245.71RVU20B
2020-01-01$387.01$245.71RVU20A
2019-10-01$389.83$245.89RVU19D
2019-07-01$389.83$245.89RVU19C
2019-04-01$389.83$245.89RVU19B
2019-01-01$389.83$245.89RVU19A
2018-10-01$390.41$246.29RVU18D
2018-07-01$390.41$246.29RVU18C
2018-04-01$390.41$246.29RVU18B
2018-01-01$390.41$246.29RVU18AR1
2017-10-01$388.97$245.96RVU17D
2017-07-01$388.97$245.96RVU17C
2017-04-01$388.97$245.96RVU17B
2017-01-01$388.97$245.96RVU17A
2016-10-01$387.86$245.35RVU16D
2016-07-01$387.86$245.35RVU16C
2016-04-01$387.86$245.35RVU16B
2016-01-01$387.86$245.35RVU16A
2015-10-01$389.20$245.84RVU15D
2015-07-01$389.20$245.84RVU15C
2015-04-01$387.27$244.62RVU15B
2015-01-01$387.27$244.62RVU15A
2014-10-01$385.32$244.54RVU14D
2014-07-01$385.32$244.54RVU14C
2014-04-01$385.32$244.54RVU14B
2014-01-01$385.32$244.54RVU14A
2013-10-01$387.67$240.38RVU13D
2013-07-01$387.67$240.38RVU13C
2013-04-01$387.67$240.38RVU13B
2013-01-01$387.67$240.38RVU13AR

Price 28126 for an earlier date of service

Where the North Carolina rate applies

North Carolina is a Medicare payment area, not a city. Our Census mapping connects it to 785 cities and communities in North Carolina. Some span more than one payment area; confirm with the service ZIP.

  • Aberdeen
  • Advance
  • Ahoskie
  • Alamance
  • Albemarle
  • Alexis
  • Alliance
  • Altamahaw

Browse all communities in North Carolina

28126 billing questions

How does this differ from 28124?

28126 describes complete excision of a toe phalanx. Use 28124 when the operative work is a partial excision instead.

Is this a toe amputation?

No. It describes removal of a phalanx, not removal of the toe as a whole.

What documentation supports reporting 28126?

The operative report should identify the toe and phalanx treated and document complete excision, rather than partial bone removal.

Can modifier 50 be used when both feet are treated?

No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this code.

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 surgeon or co-surgeon be reported?

Medicare does not pay an assistant at surgery for this code. Co-surgeons and team surgery are 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 28126PPRRVU2026_Oct_nonQPP.csv, line 3,135 (RVU26D)
Geographic factors for North CarolinaGPCI2026.csv, line 83 (RVU26D)

Open CMS sourceHow we calculate rates

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