CPT code 28291: Hallux rigidus surgery, with implant2026 Medicare rate & RVUs in Los Angeles, CA

Corrects painful, stiff first metatarsophalangeal joint arthritis with joint debridement and an implant when motion-preserving surgery is selected.

CMS RVU26DEffective Oct 1, 2026One payment locality2.7K Medicare services in 2024

In Los Angeles, CA, Medicare pays $743.51 for 28291 in the office and $474.42 when it’s performed in a hospital or facility.

$743.51Office (non-facility)
$474.42Hospital or facility
+10.9%vs the national office rate ($670.36)

Check a contract rate as a % of Medicare · 28291 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 28291 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Los Angeles, CA
  2. What 28291 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 28291 covers

A foot and ankle surgeon or podiatric surgeon uses this code for implant arthroplasty to treat symptomatic hallux rigidus at the first metatarsophalangeal joint. The procedure addresses degenerative joint changes and restricted, painful great-toe motion through joint debridement, removal of obstructive bone, capsular release, and implant placement. It is typically performed in an outpatient surgical setting when the operative plan includes an implant rather than correction without one.

Report 28291 for the documented implant procedure, not simply because imaging shows arthritis or an implant was considered. The operative report should support the hallux rigidus diagnosis, the work performed at the joint, and implant placement. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. In a same-session multiple-procedure case, the highest-valued procedure is paid in full and other procedures at 50%. Bilateral reporting with modifier 50 is paid at 150%. 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 Los Angeles, CA compares for 28291

Across 109 of 109 payment localities, the office rate for 28291 runs from $604.34 in Arkansas to $858.26 in San Benito County, CA. Los Angeles, CA pays $743.51. The RVUs are the same everywhere; the geographic indexes change the dollars.

28291 in Los Angeles, CA vs other payment areas
  1. Los Angeles, CA · this page$743.51
  2. Bakersfield, CA · California$702.91−$40.60
  3. Chico, CA · California$700.63−$42.88
  4. El Centro, CA · California$700.76−$42.75
  5. Fresno, CA · California$700.63−$42.88
  6. Hanford, CA · California$700.63−$42.88
  7. Madera, CA · California$700.63−$42.88

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

Every other payment area

28291 in every other Medicare payment locality
Payment localityOfficeFacility
Merced, CACalifornia$700.63$451.34
Modesto, CACalifornia$700.63$451.34
Napa, CACalifornia$797.53$497.74
Oxnard, CACalifornia$738.75$469.89
Redding, CACalifornia$700.63$451.34
Rest of CaliforniaCalifornia$700.63$451.34
Riverside, CACalifornia$708.52$459.22
Sacramento, CACalifornia$731.42$466.88

28291 rates by state

Office rate range in each state. Select a state to see its payment localities.

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.

$604.34

$815.04

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

View every state and territory as a table
28291 office rate range by state
State / territoryOffice rate rangeLocalities
AK$815.041
AL$611.741
AR$604.341
AZ$654.941
CA$700.63–$858.2629
CO$692.891
CT$710.301
DC$755.771
DE$664.611
FL$665.49–$722.933
GA$633.35–$682.142
GU$713.041
HI$713.041
IA$623.091
ID$626.851
IL$650.36–$705.254
IN$629.861
KS$621.431
KY$625.531
LA$625.02–$650.892
MA$690.08–$753.182
MD$675.62–$755.773
ME$630.43–$658.012
MI$639.92–$673.362
MN$664.601
MO$616.54–$651.903
MS$610.501
MT$670.311
NC$635.851
ND$656.071
NE$625.721
NH$683.151
NJ$718.58–$750.102
NM$643.201
NV$666.731
NY$643.94–$780.515
OH$637.011
OK$623.751
OR$661.67–$711.162
PA$637.43–$695.502
PR$674.241
RI$685.431
SC$637.451
SD$654.391
TN$624.151
TX$633.96–$690.498
UT$644.781
VA$656.73–$755.772
VI$674.241
VT$654.621
WA$688.43–$766.492
WI$637.531
WV$630.231
WY$664.101

See 28291 in every payment locality

How the 28291 rate is calculated

Each of 28291’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 · 28291

RVUs × geographic indexes × conversion factor

Office or facility?

Work7.81

7.81 RVUs× 1.000 GPCI

Practice expense11.54

11.54 RVUs× 1.000 GPCI

Malpractice0.72

0.72 RVUs× 1.000 GPCI

Adjusted RVUs

20.0700

Conversion factor

$33.4009

Medicare rate

$670.36

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

The exact Los Angeles, CA inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

3,172

Code
28291
Physician work
7.81
Practice expense
11.54
Malpractice
0.72

GPCI2026.csv

13

Locality
Los Angeles, CA
Physician work
1.041
Practice expense
1.183
Malpractice
0.664
Office calculation for 28291 in Los Angeles, CA
ComponentRVULocality factorAdjusted
Physician work7.81× 1.0418.1302
Practice expense11.54× 1.18313.6518
Malpractice0.72× 0.6640.4781
Total RVUs22.2601
Conversion factor× 33.4009

Office rate, Los Angeles, CA$743.51

Office: (7.81 × 1.041 + 11.54 × 1.183 + 0.72 × 0.664) × $33.4009 = $743.51

Facility: (7.81 × 1.041 + 4.73 × 1.183 + 0.72 × 0.664) × $33.4009 = $474.42

Open 28291 in the RVU calculator

Payment rules and modifiers for 28291

28291 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 28291

Hallux rigidus surgery, with implant

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 · 28291

Hallux rigidus surgery, with implant

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

28291 without 50 · national office

$670.36

Hallux rigidus surgery, with implant

28291-50 · Bilateral: 150%

$1,005.54

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

How 28291 has changed in Los Angeles, CA

28291 · Office / nonfacility

$743.51

Effective 2026-10-01

The base rate is $6.97 higher than on 2025-10-01, moving from $736.54 to $743.51 (0.9%).

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

    $736.54changed to$743.51

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 8.01 changed to 7.81
    • Practice expense RVU 11.67 changed to 11.54
    • Malpractice RVU 0.71 changed to 0.72
    • Work GPCI 1.042 changed to 1.041
    • Practice expense GPCI 1.194 changed to 1.183
    • Malpractice GPCI 0.690 changed to 0.664

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $768.59changed to$736.54

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 11.92 changed to 11.67
    • Malpractice RVU 0.74 changed to 0.71

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $756.05changed to$768.59

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $782.72changed to$756.05

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 11.97 changed to 11.92
    • Malpractice RVU 0.75 changed to 0.74
    • Work GPCI 1.045 changed to 1.042
    • Practice expense GPCI 1.185 changed to 1.194
    • Malpractice GPCI 0.724 changed to 0.690
  5. January 1, 2023

    RVU23A

    $804.43changed to$782.72

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 12.13 changed to 11.97
    • Malpractice RVU 0.79 changed to 0.75
    • Work GPCI 1.048 changed to 1.045
    • Practice expense GPCI 1.175 changed to 1.185
    • Malpractice GPCI 0.757 changed to 0.724

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $835.84changed to$804.43

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 12.74 changed to 12.13
    • Malpractice RVU 0.78 changed to 0.79

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $844.15changed to$835.84

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 12.29 changed to 12.74
    • Malpractice RVU 0.76 changed to 0.78
    • Work GPCI 1.047 changed to 1.048
    • Practice expense GPCI 1.176 changed to 1.175
    • Malpractice GPCI 0.725 changed to 0.757

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $842.25changed to$844.15

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 12.36 changed to 12.29
    • Malpractice RVU 0.64 changed to 0.76
    • Work GPCI 1.046 changed to 1.047
    • Practice expense GPCI 1.177 changed to 1.176
    • Malpractice GPCI 0.694 changed to 0.725

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $842.19changed to$842.25

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 12.41 changed to 12.36
    • Malpractice RVU 0.59 changed to 0.64

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $841.66changed to$842.19

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 12.36 changed to 12.41
    • Malpractice RVU 0.77 changed to 0.59
    • Work GPCI 1.047 changed to 1.046
    • Practice expense GPCI 1.169 changed to 1.177
    • Malpractice GPCI 0.801 changed to 0.694

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    No ratechanged to$841.66

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2013

    RVU13AR

    Earliest loaded release: No rate

    Held through RVU13B, RVU13C, RVU13D, RVU14A, RVU14B, RVU14C, RVU14D, RVU15A, RVU15B, RVU15C, RVU15D, RVU16A, RVU16B, RVU16C, RVU16D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$743.51$474.42RVU26D
2026-07-01$743.51$474.42RVU26C
2026-04-01$743.51$474.42RVU26B
2026-01-01$743.51$474.42RVU26A
2025-10-01$736.54$509.44RVU25D
2025-07-01$736.54$509.44RVU25C
2025-04-01$736.54$509.44RVU25B
2025-01-01$736.54$509.44RVU25A
2024-10-01$768.59$524.16RVU24D
2024-07-01$768.59$524.16RVU24C
2024-04-01$768.59$524.16RVU24B
2024-03-09$768.59$524.16RVU24AR
2024-01-01$756.05$515.60RVU24A
2023-10-01$782.72$530.14RVU23D
2023-07-01$782.72$530.14RVU23C
2023-04-01$782.72$530.14RVU23B
2023-01-01$782.72$530.14RVU23A
2022-10-01$804.43$539.31RVU22D
2022-07-01$804.43$539.31RVU22C
2022-04-01$804.43$539.31RVU22B
2022-01-01$804.43$539.31RVU22A
2021-10-01$835.84$543.11RVU21D
2021-07-01$835.84$543.11RVU21C
2021-04-01$835.84$543.11RVU21B
2021-01-01$835.84$543.11RVU21A
2020-10-01$844.15$549.19RVU20D
2020-07-01$844.15$549.19RVU20C
2020-04-01$844.15$549.19RVU20B
2020-01-01$844.15$549.19RVU20A
2019-10-01$842.25$538.96RVU19D
2019-07-01$842.25$538.96RVU19C
2019-04-01$842.25$538.96RVU19B
2019-01-01$842.25$538.96RVU19A
2018-10-01$842.19$530.76RVU18D
2018-07-01$842.19$530.76RVU18C
2018-04-01$842.19$530.76RVU18B
2018-01-01$842.19$530.76RVU18AR1
2017-10-01$841.66$535.40RVU17D
2017-07-01$841.66$535.40RVU17C
2017-04-01$841.66$535.40RVU17B
2017-01-01$841.66$535.40RVU17A
2016-10-01Not in this releaseNot in this releaseRVU16D
2016-07-01Not in this releaseNot in this releaseRVU16C
2016-04-01Not in this releaseNot in this releaseRVU16B
2016-01-01Not in this releaseNot in this releaseRVU16A
2015-10-01Not in this releaseNot in this releaseRVU15D
2015-07-01Not in this releaseNot in this releaseRVU15C
2015-04-01Not in this releaseNot in this releaseRVU15B
2015-01-01Not in this releaseNot in this releaseRVU15A
2014-10-01Not in this releaseNot in this releaseRVU14D
2014-07-01Not in this releaseNot in this releaseRVU14C
2014-04-01Not in this releaseNot in this releaseRVU14B
2014-01-01Not in this releaseNot in this releaseRVU14A
2013-10-01Not in this releaseNot in this releaseRVU13D
2013-07-01Not in this releaseNot in this releaseRVU13C
2013-04-01Not in this releaseNot in this releaseRVU13B
2013-01-01Not in this releaseNot in this releaseRVU13AR

Price 28291 for an earlier date of service

Where the Los Angeles, CA rate applies

Los Angeles, CA is a Medicare payment area, not a city. Our Census mapping connects it to 189 cities and communities in California. Some span more than one payment area; confirm with the service ZIP.

  • Anaheim
  • Long Beach
  • Los Angeles
  • Orange
  • Acton
  • Agoura Hills
  • Agua Dulce
  • Alhambra

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28291 billing questions

When should 28291 be chosen instead of 28289?

Use 28291 when the hallux rigidus correction includes implant placement. Code 28289 describes the corresponding correction without an implant.

Does the code include the joint debridement and capsular release?

Yes. These are part of the described hallux rigidus correction; do not separately report them as though they were unrelated procedures.

What operative documentation supports 28291?

Document the symptomatic first metatarsophalangeal joint condition, the correction performed, and placement of the implant. The operative note should make clear that the procedure was an implant correction rather than correction without an implant.

How is modifier 50 handled for bilateral surgery?

CMS pays bilateral reporting with modifier 50 at 150%. The record should support that the same procedure was performed on both sides.

How does CMS handle other procedures performed in the same session?

The highest-valued procedure is paid in full, and other procedures are paid at 50%. Related postoperative care is included in the 90-day global period.

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 28291PPRRVU2026_Oct_nonQPP.csv, line 3,172 (RVU26D)
Geographic factors for Los Angeles, CAGPCI2026.csv, line 13 (RVU26D)

Open CMS sourceHow we calculate rates

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