CPT code 28291: Hallux rigidus surgery, with implant2026 Medicare rate & RVUs in North Carolina
Corrects painful, stiff first metatarsophalangeal joint arthritis with joint debridement and an implant when motion-preserving surgery is selected.
In North Carolina, Medicare pays $635.85 for 28291 in the office and $423.63 when it’s performed in a hospital or facility.
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.
On this page 11 sections
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 North Carolina 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. North Carolina pays $635.85. The RVUs are the same everywhere; the geographic indexes change the dollars.
- North Carolina · this page$635.85
- Los Angeles, CA · California$743.51+$107.66
- Washington, DC area · District of Columbia$755.77+$119.92
- Miami, FL · Florida$722.93+$87.08
- Chicago, IL · Illinois$705.25+$69.40
- Manhattan, NY · New York$763.59+$127.74
- Alaska · Alaska$815.04+$179.19
Other areas in North Carolina first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $611.74 | $412.71 |
| ArkansasArkansas | $604.34 | $408.96 |
| ArizonaArizona | $654.94 | $434.54 |
| Bakersfield, CACalifornia | $702.91 | $453.62 |
| Chico, CACalifornia | $700.63 | $451.34 |
| El Centro, CACalifornia | $700.76 | $451.46 |
| Fresno, CACalifornia | $700.63 | $451.34 |
| Hanford, CACalifornia | $700.63 | $451.34 |
| Madera, CACalifornia | $700.63 | $451.34 |
| 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 |
| Salinas, CACalifornia | $728.57 | $464.94 |
| San Diego, CACalifornia | $742.72 | $470.67 |
| Marin County, CACalifornia | $840.16 | $519.44 |
| San Francisco, CACalifornia | $839.34 | $518.62 |
| San Benito County, CACalifornia | $858.26 | $530.26 |
| Santa Clara County, CACalifornia | $854.92 | $526.92 |
| San Luis Obispo, CACalifornia | $717.21 | $458.13 |
| Santa Cruz, CACalifornia | $747.55 | $471.18 |
| Santa Maria, CACalifornia | $730.49 | $465.27 |
| Santa Rosa, CACalifornia | $754.91 | $475.58 |
| Stockton, CACalifornia | $700.63 | $451.34 |
| Vallejo, CACalifornia | $796.35 | $496.56 |
| Visalia, CACalifornia | $700.63 | $451.34 |
| Yuba City, CACalifornia | $700.63 | $451.34 |
| ColoradoColorado | $692.89 | $450.87 |
| ConnecticutConnecticut | $710.30 | $465.33 |
| DelawareDelaware | $664.61 | $439.88 |
| Fort Lauderdale, FLFlorida | $694.80 | $464.38 |
| Rest of FloridaFlorida | $665.49 | $448.04 |
| Atlanta, GAGeorgia | $682.14 | $451.04 |
| Rest of GeorgiaGeorgia | $633.35 | $430.45 |
| Hawaii, Guam, HIHawaii | $713.04 | $454.42 |
| IowaIowa | $623.09 | $414.97 |
| IdahoIdaho | $626.85 | $417.58 |
| East St. Louis, ILIllinois | $663.91 | $454.64 |
| Rest of IllinoisIllinois | $650.36 | $442.69 |
| Suburban Chicago, ILIllinois | $701.15 | $467.55 |
| IndianaIndiana | $629.86 | $419.00 |
| KansasKansas | $621.43 | $415.80 |
| KentuckyKentucky | $625.53 | $423.32 |
| New Orleans, LALouisiana | $650.89 | $436.85 |
| Rest of LouisianaLouisiana | $625.02 | $423.72 |
| Metropolitan Boston, MAMassachusetts | $753.18 | $481.60 |
| Rest of MassachusettsMassachusetts | $690.08 | $450.56 |
| Baltimore area, MDMaryland | $708.37 | $464.30 |
| Rest of MarylandMaryland | $675.62 | $445.43 |
| Rest of MaineMaine | $630.43 | $421.17 |
| Southern Maine, MEMaine | $658.01 | $432.60 |
| Detroit, MIMichigan | $673.36 | $453.86 |
| Rest of MichiganMichigan | $639.92 | $432.25 |
| MinnesotaMinnesota | $664.60 | $430.55 |
| Metropolitan Kansas City, MOMissouri | $646.29 | $432.71 |
| Metropolitan St. Louis, MOMissouri | $651.90 | $435.36 |
| Rest of MissouriMissouri | $616.54 | $420.47 |
| MississippiMississippi | $610.50 | $414.66 |
| MontanaMontana | $670.31 | $442.85 |
| North DakotaNorth Dakota | $656.07 | $428.61 |
| NebraskaNebraska | $625.72 | $415.77 |
| New HampshireNew Hampshire | $683.15 | $446.37 |
| Northern New JerseyNew Jersey | $750.10 | $486.24 |
| Rest of New JerseyNew Jersey | $718.58 | $470.20 |
| New MexicoNew Mexico | $643.20 | $434.62 |
| NevadaNevada | $666.73 | $439.04 |
| NYC suburbs and Long Island, NYNew York | $780.51 | $510.06 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $723.76 | $474.69 |
| Queens, NYNew York | $767.83 | $498.97 |
| Rest of New YorkNew York | $643.94 | $427.85 |
| OhioOhio | $637.01 | $429.34 |
| OklahomaOklahoma | $623.75 | $420.63 |
| Portland, OROregon | $711.16 | $458.45 |
| Rest of OregonOregon | $661.67 | $435.12 |
| Metropolitan Philadelphia, PAPennsylvania | $695.50 | $458.71 |
| Rest of PennsylvaniaPennsylvania | $637.43 | $428.62 |
| Puerto RicoPuerto Rico | $674.24 | $444.27 |
| Rhode IslandRhode Island | $685.43 | $450.47 |
| South CarolinaSouth Carolina | $637.45 | $427.28 |
| South DakotaSouth Dakota | $654.39 | $426.93 |
| TennesseeTennessee | $624.15 | $417.38 |
| Austin, TXTexas | $690.49 | $449.84 |
| Beaumont, TXTexas | $633.96 | $426.97 |
| Brazoria, TXTexas | $663.68 | $438.27 |
| Dallas, TXTexas | $667.75 | $441.20 |
| Fort Worth, TXTexas | $664.21 | $439.93 |
| Galveston, TXTexas | $665.61 | $439.74 |
| Houston, TXTexas | $678.79 | $452.92 |
| Rest of TexasTexas | $648.37 | $432.51 |
| UtahUtah | $644.78 | $430.96 |
| VirginiaVirginia | $656.73 | $433.14 |
| Virgin Islands, VIUnited States Virgin Islands | $674.24 | $444.27 |
| VermontVermont | $654.62 | $429.44 |
| Rest of WashingtonWashington | $688.43 | $448.91 |
| King County, WAWashington | $766.49 | $487.40 |
| WisconsinWisconsin | $637.53 | $419.62 |
| West VirginiaWest Virginia | $630.23 | $432.56 |
| WyomingWyoming | $664.10 | $436.64 |
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
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $815.04 | 1 |
| AL | $611.74 | 1 |
| AR | $604.34 | 1 |
| AZ | $654.94 | 1 |
| CA | $700.63–$858.26 | 29 |
| CO | $692.89 | 1 |
| CT | $710.30 | 1 |
| DC | $755.77 | 1 |
| DE | $664.61 | 1 |
| FL | $665.49–$722.93 | 3 |
| GA | $633.35–$682.14 | 2 |
| GU | $713.04 | 1 |
| HI | $713.04 | 1 |
| IA | $623.09 | 1 |
| ID | $626.85 | 1 |
| IL | $650.36–$705.25 | 4 |
| IN | $629.86 | 1 |
| KS | $621.43 | 1 |
| KY | $625.53 | 1 |
| LA | $625.02–$650.89 | 2 |
| MA | $690.08–$753.18 | 2 |
| MD | $675.62–$755.77 | 3 |
| ME | $630.43–$658.01 | 2 |
| MI | $639.92–$673.36 | 2 |
| MN | $664.60 | 1 |
| MO | $616.54–$651.90 | 3 |
| MS | $610.50 | 1 |
| MT | $670.31 | 1 |
| NC | $635.85 | 1 |
| ND | $656.07 | 1 |
| NE | $625.72 | 1 |
| NH | $683.15 | 1 |
| NJ | $718.58–$750.10 | 2 |
| NM | $643.20 | 1 |
| NV | $666.73 | 1 |
| NY | $643.94–$780.51 | 5 |
| OH | $637.01 | 1 |
| OK | $623.75 | 1 |
| OR | $661.67–$711.16 | 2 |
| PA | $637.43–$695.50 | 2 |
| PR | $674.24 | 1 |
| RI | $685.43 | 1 |
| SC | $637.45 | 1 |
| SD | $654.39 | 1 |
| TN | $624.15 | 1 |
| TX | $633.96–$690.49 | 8 |
| UT | $644.78 | 1 |
| VA | $656.73–$755.77 | 2 |
| VI | $674.24 | 1 |
| VT | $654.62 | 1 |
| WA | $688.43–$766.49 | 2 |
| WI | $637.53 | 1 |
| WV | $630.23 | 1 |
| WY | $664.10 | 1 |
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
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 North Carolina 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
83
- Locality
- North Carolina
- Physician work
- 1.000
- Practice expense
- 0.933
- Malpractice
- 0.639
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 7.81 | × 1.000 | 7.8100 |
| Practice expense | 11.54 | × 0.933 | 10.7668 |
| Malpractice | 0.72 | × 0.639 | 0.4601 |
| Total RVUs | 19.0369 | ||
| Conversion factor | × 33.4009 | ||
Office rate, North Carolina$635.85
Office: (7.81 × 1 + 11.54 × 0.933 + 0.72 × 0.639) × $33.4009 = $635.85
Facility: (7.81 × 1 + 4.73 × 0.933 + 0.72 × 0.639) × $33.4009 = $423.63
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
| 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) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| 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 · 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.
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).
How 28291 has changed in North Carolina
28291 · Office / nonfacility
$635.85
Effective 2026-10-01
The base rate is $11.93 higher than on 2025-10-01, moving from $623.92 to $635.85 (1.9%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
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
January 1, 2026
RVU26A
$623.92changed to$635.85
- 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
- Practice expense GPCI 0.926 changed to 0.933
- Malpractice GPCI 0.665 changed to 0.639
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$650.44changed to$623.92
- 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.
March 9, 2024
RVU24AR
$639.82changed to$650.44
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$666.31changed to$639.82
- 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
- Practice expense GPCI 0.927 changed to 0.926
- Malpractice GPCI 0.742 changed to 0.665
January 1, 2023
RVU23A
$689.14changed to$666.31
- 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
- Practice expense GPCI 0.928 changed to 0.927
- Malpractice GPCI 0.819 changed to 0.742
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$714.32changed to$689.14
- 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.
January 1, 2021
RVU21A
$722.33changed to$714.32
- 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
- Practice expense GPCI 0.930 changed to 0.928
- Malpractice GPCI 0.757 changed to 0.819
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$719.41changed to$722.33
- 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
- Practice expense GPCI 0.931 changed to 0.930
- Malpractice GPCI 0.695 changed to 0.757
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$719.05changed to$719.41
- 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.
January 1, 2018
RVU18AR1
$720.67changed to$719.05
- 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
- Malpractice GPCI 0.732 changed to 0.695
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
No ratechanged to$720.67
Held through RVU17B, RVU17C, RVU17D.
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.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $635.85 | $423.63 | RVU26D |
| 2026-07-01 | $635.85 | $423.63 | RVU26C |
| 2026-04-01 | $635.85 | $423.63 | RVU26B |
| 2026-01-01 | $635.85 | $423.63 | RVU26A |
| 2025-10-01 | $623.92 | $447.79 | RVU25D |
| 2025-07-01 | $623.92 | $447.79 | RVU25C |
| 2025-04-01 | $623.92 | $447.79 | RVU25B |
| 2025-01-01 | $623.92 | $447.79 | RVU25A |
| 2024-10-01 | $650.44 | $460.87 | RVU24D |
| 2024-07-01 | $650.44 | $460.87 | RVU24C |
| 2024-04-01 | $650.44 | $460.87 | RVU24B |
| 2024-03-09 | $650.44 | $460.87 | RVU24AR |
| 2024-01-01 | $639.82 | $453.35 | RVU24A |
| 2023-10-01 | $666.31 | $468.72 | RVU23D |
| 2023-07-01 | $666.31 | $468.72 | RVU23C |
| 2023-04-01 | $666.31 | $468.72 | RVU23B |
| 2023-01-01 | $666.31 | $468.72 | RVU23A |
| 2022-10-01 | $689.14 | $479.75 | RVU22D |
| 2022-07-01 | $689.14 | $479.75 | RVU22C |
| 2022-04-01 | $689.14 | $479.75 | RVU22B |
| 2022-01-01 | $689.14 | $479.75 | RVU22A |
| 2021-10-01 | $714.32 | $483.12 | RVU21D |
| 2021-07-01 | $714.32 | $483.12 | RVU21C |
| 2021-04-01 | $714.32 | $483.12 | RVU21B |
| 2021-01-01 | $714.32 | $483.12 | RVU21A |
| 2020-10-01 | $722.33 | $489.07 | RVU20D |
| 2020-07-01 | $722.33 | $489.07 | RVU20C |
| 2020-04-01 | $722.33 | $489.07 | RVU20B |
| 2020-01-01 | $722.33 | $489.07 | RVU20A |
| 2019-10-01 | $719.41 | $479.51 | RVU19D |
| 2019-07-01 | $719.41 | $479.51 | RVU19C |
| 2019-04-01 | $719.41 | $479.51 | RVU19B |
| 2019-01-01 | $719.41 | $479.51 | RVU19A |
| 2018-10-01 | $719.05 | $472.71 | RVU18D |
| 2018-07-01 | $719.05 | $472.71 | RVU18C |
| 2018-04-01 | $719.05 | $472.71 | RVU18B |
| 2018-01-01 | $719.05 | $472.71 | RVU18AR1 |
| 2017-10-01 | $720.67 | $476.76 | RVU17D |
| 2017-07-01 | $720.67 | $476.76 | RVU17C |
| 2017-04-01 | $720.67 | $476.76 | RVU17B |
| 2017-01-01 | $720.67 | $476.76 | RVU17A |
| 2016-10-01 | Not in this release | Not in this release | RVU16D |
| 2016-07-01 | Not in this release | Not in this release | RVU16C |
| 2016-04-01 | Not in this release | Not in this release | RVU16B |
| 2016-01-01 | Not in this release | Not in this release | RVU16A |
| 2015-10-01 | Not in this release | Not in this release | RVU15D |
| 2015-07-01 | Not in this release | Not in this release | RVU15C |
| 2015-04-01 | Not in this release | Not in this release | RVU15B |
| 2015-01-01 | Not in this release | Not in this release | RVU15A |
| 2014-10-01 | Not in this release | Not in this release | RVU14D |
| 2014-07-01 | Not in this release | Not in this release | RVU14C |
| 2014-04-01 | Not in this release | Not in this release | RVU14B |
| 2014-01-01 | Not in this release | Not in this release | RVU14A |
| 2013-10-01 | Not in this release | Not in this release | RVU13D |
| 2013-07-01 | Not in this release | Not in this release | RVU13C |
| 2013-04-01 | Not in this release | Not in this release | RVU13B |
| 2013-01-01 | Not in this release | Not in this release | RVU13AR |
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
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
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