CPT code 28490: Toe fracture care, without manipulation2026 Medicare rate & RVUs in California
Reports closed treatment of a great toe fracture managed without manipulation, such as a stable fracture treated with immobilization and follow-up.
Medicare pays $167.70–$210.99 for 28490 in the office in California, from Chico, CA to San Benito County, CA. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
What 28490 covers
This code represents closed treatment of a great toe fracture when the treating clinician manages the fracture without manipulating it to change alignment. It commonly describes care for a stable fracture managed with measures such as buddy taping, a protective shoe, splinting, or casting. Orthopedic surgeons, podiatrists, and other clinicians who assume responsibility for fracture treatment may report it in an office, emergency, or other appropriate setting. A visit that only evaluates the injury before the patient is referred elsewhere is not the same as assuming fracture care.
Document the great toe fracture, the decision to treat it without manipulation, and the treatment plan. CMS 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 other procedures are subject to the standard 50% reduction. For bilateral treatment, modifier 50 is paid at 150%. Assistant-at-surgery services are not paid; 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.
Where 28490 pays more and less in California
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
29 payment localities
$167.70 to $210.99
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield, CA | $168.19 | $139.27 |
| Chico, CA | $167.70 | $138.78 |
| El Centro, CA | $167.73 | $138.81 |
| Fresno, CA | $167.70 | $138.78 |
| Hanford, CA | $167.70 | $138.78 |
| Los Angeles, CA | $179.33 | $148.12 |
| Madera, CA | $167.70 | $138.78 |
| Marin County, CA | $206.31 | $169.10 |
| Merced, CA | $167.70 | $138.78 |
| Modesto, CA | $167.70 | $138.78 |
| Napa, CA | $194.80 | $160.02 |
| Oxnard, CA | $178.49 | $147.30 |
| Redding, CA | $167.70 | $138.78 |
| Rest of California | $167.70 | $138.78 |
| Riverside, CA | $169.54 | $140.62 |
| Sacramento, CA | $176.12 | $145.43 |
| Salinas, CA | $175.47 | $144.89 |
| San Benito County, CA | $210.99 | $172.94 |
| San Diego, CA | $179.72 | $148.16 |
| San Francisco, CA | $206.12 | $168.91 |
| San Luis Obispo, CA | $172.64 | $142.58 |
| Santa Clara County, CA | $210.20 | $172.15 |
| Santa Cruz, CA | $181.52 | $149.46 |
| Santa Maria, CA | $176.16 | $145.39 |
| Santa Rosa, CA | $183.36 | $150.96 |
| Stockton, CA | $167.70 | $138.78 |
| Vallejo, CA | $194.52 | $159.74 |
| Visalia, CA | $167.70 | $138.78 |
| Yuba City, CA | $167.70 | $138.78 |
How the 28490 rate is calculated
Each of 28490’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 · 28490
RVUs × geographic indexes × conversion factor
Work1.14
1.14 RVUs× 1.000 GPCI
Practice expense3.44
3.44 RVUs× 1.000 GPCI
Malpractice0.17
0.17 RVUs× 1.000 GPCI
Adjusted RVUs
4.7500
Conversion factor
$33.4009
Medicare rate
$158.65
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 28490
28490 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 28490
Toe fracture care, without manipulation
| 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) | 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 · 28490
Toe fracture care, without manipulation
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
28490 without 50 · national office
$158.65
Toe fracture care, without manipulation
28490-50 · Bilateral: 150%
$237.98
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).
28490 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 28495Toe fracture treatmentGreat toe, with manipulation
- Both concern closed treatment of a great toe fracture. Choose 28490 when treatment proceeds without manipulation and 28495 when the clinician manipulates the fracture.
- 28496Great toe fracturePercutaneous fixation with manipulation
- 28496 involves percutaneous skeletal fixation with manipulation; 28490 is closed treatment without manipulation or percutaneous fixation.
- 28510Toe fracture careWithout manipulation
- 28510 is for a fracture of a toe other than the great toe treated without manipulation. Use 28490 for the great toe.
- 28470Metatarsal fracture careWithout manipulation, each
- 28470 concerns closed treatment without manipulation of a metatarsal fracture. 28490 is for a fracture of the great toe.
28490 billing questions
How is 28490 distinguished from 28495?
Use 28490 when the great toe fracture is treated without manipulation. When the clinician manipulates the fracture to alter alignment, consider 28495 instead.
When is 28496 considered instead?
28496 describes percutaneous skeletal fixation of a great toe fracture with manipulation. It is not the code for closed treatment without manipulation.
Does routine fracture follow-up fall within this code's global period?
CMS assigns 28490 a 90-day global period. The day-before preoperative visit and 90 days of related postoperative care are included.
How is treatment of both great toes handled?
CMS identifies this as a bilateral procedure; modifier 50 is paid at 150%. Document treatment of both sides.
Can an assistant, co-surgeon, or surgical team be paid for this service?
CMS applies a statutory restriction to assistant-at-surgery payment. Co-surgeons and team surgery are not permitted for this code.
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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